Bones (arm) 70% increased risk of fracture Davidson P et al (2003) Biomechanical analysis of arm fracture in obese boys heart attack youtube order terazosin 5mg without a prescription. Kidney Increased risk of impaired renal function Csernus K et al (2005) Effect of childhood obesity and obesity-related cardiovascular risk factors on glomerular and tubular protein excretion arteria umbilical discount 1mg terazosin overnight delivery. Legs Reduced exercise tolerance Marinov B et al (2002) Ventilatory efficiency and rate of perceived exertion in obese and non-obese children performing standardized exercise blood pressure chart cdc discount 1 mg terazosin amex. This is largely because 4 out of 5 ovarian cancer patients are diagnosed with advanced disease that has spread throughout the abdominal cavity pulmonary venous hypertension xray discount 2 mg terazosin free shipping. Improving the ability to detect ovarian cancer early is a research priority, given that women diagnosed with localized-stage disease have more than a 90% five-year survival rate. Although advancing knowledge about ovarian cancer has been hindered by substantial disease heterogeneity and uncertainties about tumor tissues of origin, understanding of the disease has evolved rapidly in recent years, especially for epithelial tumors, the most common subtype. This special section provides information about ovarian cancer risk factors, incidence and mortality rates and trends, early detection, and treatment that is primarily related to epithelial tumors. Female Reproductive Anatomy Fallopian tube Uterine cavity Fundus of uterus Ovary Broad Ligament Ligament of ovary Cervix Vagina Fimbriae Infundibulum Cervical canal What is ovarian cancer? The ovaries are a pair of reproductive glands, each about the size of a grape, located on either side of the uterus (Figure S1). They produce eggs that travel through the fallopian tubes into the uterus, where they are fertilized for reproduction. In premenopausal women, the ovaries are the primary source of the hormones estrogen and progesterone, which maintain the health of the female reproductive system. The three major types of ovarian cancer are epithelial, accounting for 90% of cases, germ cell (3%), and sex cord-stromal (2%) (Figure S2). As biological understanding has evolved, epithelial subtypes are increasingly characterized as distinct diseases with different molecular pathways, risk factors, and treatment. They are also called tumors of low malignant potential because they do not usually grow into the stroma (the supportive tissue around the ovary), with 5-year survival rates greater than 98%. Distribution (%) of Major Types of Ovarian Cancer* by Race/Ethnicity, 2010-2014 Epithelial Germ cell Sex cord-stromal Other or unspecified All races 90 3 2 5 Non-Hispanic white 91 2 2 5 Non-Hispanic black 82 5 6 7 Asian/ Pacific Islander 90 5 2 4 Hispanic 84 7 3 6 0 20 40 60 80 100 Percent *Data are based on microscopically confirmed cases. Persons of Hispanic origin may be of any race; Asians/Pacific Islanders include those of Hispanic and non-Hispanic origin. American Indians and Alaska Natives are not shown due to <25 cases reported for certain subtypes. In contrast, endometrioid and clear cell tumors are thought to originate in the endometrium (lining of the uterus), while mucinous tumors may originate in the ovaries or fallopian tube-peritoneal junction; these subtypes typically affect only one ovary. Germ cell tumors arise from the germ (egg) cells of the ovary and primarily occur in adolescents and young women. Sex cord-stromal tumors form in the supportive tissue of the ovaries and can arise from different cells, including granulosa, Sertoli, and Leydig cells. Sex cordstromal tumors generally occur most often in women in their 50s, although certain types are more common in adolescents and young women. For all women combined, incidence peaks in the late 70s for epithelial tumors, in the 50s for sex cord-stromal tumors, and in ages 15-19 years for germ cell tumors. In contrast, incidence of sex cord-stromal tumors is highest in black women from around age 30. Surveillance Research Program, Statistical Methodology and Applications, National Cancer Institute, 2017. Similarly, rates vary only slightly among states due, in part, to the lack of advances in early detection, which often exacerbate disparities. Some of the variation in ovarian cancer risk is explained by differences in the prevalence of reproductive risk factors, such as number of childbirths, use of oral contraceptives, and tubal ligation, but the source of most of the variation remains unknown. Despite this, black women have the second-highest mortality rates, likely due in part to later stage at diagnosis, a lower likelihood of receiving optimal treatment, and more comorbidities. Persons of Hispanic origin may be of any race; American Indians/Alaska Natives and Asians/Pacific Islanders include those of Hispanic and non-Hispanic origin. American Indians and Alaska Natives are not shown due to <25 cases reported for several age groups. Incidence trends Overall ovarian cancer incidence rates have been decreasing since the mid-1980s, with the pace of the decline accelerating in the early 2000s. Similar to incidence, mortality rates have decreased in women younger than 65 years since at least 1975, but only since the mid-2000s in women 65 years and older (Figure S5, page 32). Note: American Indians and Alaska Natives not pictured due to <25 deaths in some years. Rates for Hispanics exclude data from Louisiana, New Hampshire, and Oklahoma due to missing data on Hispanic ethnicity for some years. Most of the current information on factors associated with ovarian cancer risk is from studies of epithelial tumors. The strongest risk factor for ovarian cancer is a family history of breast or ovarian cancer. Understanding and discovery of these types of gene mutations and their potential utility in a clinical setting for risk prediction and cancer prevention continue to evolve. Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer syndrome, is a rare hereditary condition associated with an increased risk for several cancers in addition to colorectal, including ovarian. Women with Lynch syndrome have approximately an 8% risk of developing ovarian cancer by age 70. Among women who use oral contraceptives for five to nine years total, risk is reduced by about 35%. While more studies examining the association between fertility drugs and ovarian cancer risk are needed, thus far there is little evidence of an association. Results from studies evaluating whether this relationship varies by epithelial subtype are inconsistent. Risk is increased even with short duration of hormone use and remains elevated for at least 10 years after discontinuation. The association appears to be confined to serous and endometrioid carcinoma, the two most common epithelial subtypes. Smoking Cigarette smoking increases the risk of mucinous ovarian cancer and decreases risk for endometrioid and clear cell carcinoma. Of the large prospective studies, one found a slightly increased risk of invasive serous carcinoma among ever talc powder users,95 while the other found no relationship among perineal powder users. When ovarian cancer is suspected, patients will be asked to provide a full medical history and undergo a physical examination focused on the pelvis, checking for an enlarged ovary and/or fluid in the abdomen. Blood tests may help identify some types of ovarian cancer, primarily germ cell tumors. If abdominal fluid is detected, a sample may be removed and examined for cancer cells using a procedure called paracentesis, in which a thin needle is inserted into the abdomen. Surgery with a tumor biopsy is usually required to confirm disease and determine histologic subtype and stage. In patients who are unable to undergo surgery, a tumor specimen may be taken through fine needle biopsy, in which a needle is placed directly into the tumor through the skin using imaging guidance, or during laparoscopy. Imaging of the chest and examination of the colon and rectum using colonoscopy may also be used to assess the spread of disease. Early ovarian cancer usually has no obvious symptoms, which is why the disease is typically diagnosed at an advanced stage. However, studies indicate that some women experience persistent, nonspecific symptoms, such as back pain, bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, or urinary urgency or frequency, in the months prior to diagnosis. The most common sign of ovarian cancer is swelling of the abdomen, which is caused by the accumulation of fluid from the cancer (ascites). Currently, there is no recommended screening test for the early detection of ovarian cancer in average-risk women, although studies to identify effective screening strategies are ongoing. Most ovarian cancer patients (60%) are diagnosed with distant-stage disease, for which 5-year survival is 29% (Figure S6; Table S3). As a result, the overall 5-year relative survival rate for ovarian cancer is low (47%; Table S3). Ovarian cancer survival also varies substantially by age and race/ethnicity (Table S3).
Pneumococcal bacteria can spread from person to person by direct contact with respiratory secretions hypertension yeast infection terazosin 2mg discount, like saliva or mucus blood pressure healthy numbers order 2 mg terazosin visa. People can carry the bacteria in their nose and throat blood pressure monitor reviews terazosin 2mg online, and can spread the bacteria without feeling sick blood pressure of 80/50 safe terazosin 1 mg. Addressing Common Questions about Pneumococcal Vaccination for Adults Who should get these vaccines? It is recommended for: · All adults 65 years or older · Adults 19 years or older with certain health conditions, like chronic illnesses of the heart, liver, lungs, or kidneys · Adults 19 years or older who smoke cigarettes · Adults 19 years or older with an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant Who should not get these vaccines? Is it safe to get if I have certain health conditions or am taking prescription meds? Unless you have had an allergic reaction in the past to the vaccine or have allergies to certain components of the vaccine, it is safe to get. Check with your insurance provider for details on whether there is any cost to you and for a list of in-network vaccine providers. Medicare Part B covers the cost of both pneumococcal vaccines (when administered at least 12 months apart). Pneumococcal vaccines may be available at private doctor offices, public or community health clinics, pharmacies, or other community locations (such as schools/universities, workplaces, religious centers or places of worship). The eight core functions are as follows: Health information and data this function provides a defined data set that includes such items as medical and nursing diagnoses, a medication list, allergies, demographics, clinical narratives, and laboratory test results. Further, it provides improved access to information needed by care providers when they need it. Result management Computerized results can be accessed more easily (than paper reports) by the provider at the time and place they are needed. Reduced lag time allows for quicker recognition and treatment of medical problems. The automated display of previous test results makes it possible to reduce redundant and additional testing. Having electronic results can allow for better interpretation and for easier detection of abnormalities, thereby ensuring appropriate follow-up. Access to electronic consults and patient consents can establish critical links and improve care coordination among multiple providers, as well as between provider and patient. Decision support Computerized decision support systems include prevention, prescribing of drugs, diagnosis and management, and detection of adverse events and disease outbreaks. Computer reminders and prompts improve preventive practices in areas such as vacci- nations, breast cancer screening, colorectal screening, and cardiovascular risk reduction. Secure e-mail and web messaging have been shown to be effective in facilitating com- munication both among providers and with patients, thus allowing for greater continuity of care and more timely interventions. Automatic alerts to providers regarding abnormal laboratory results reduce the time until an appropriate treatment is ordered. Electronic communication is fundamental to the creation of an integrated health record, both within a setting and across settings and institutions. Patient support Computer-based patient education has been found to be successful in improving control of chronic illnesses, such as diabetes, in primary care. Examples of home monitoring by patients using electronic devices include self- testing by patients with asthma (spirometry), glucose monitors for patients with diabetes, and Holter monitors for patients with heart conditions. Administrative processes and reporting Electronic scheduling systems increase the efficiency of healthcare organizations and provide better, timelier service to patients. Communication and content standards are important in the billing and claims man- agement area. Electronic authorization and prior approvals can eliminate delays and confusion; immediate validation of insurance eligibility results in more timely payments and less paperwork. Reporting and population health Public- and private-sector reporting requirements at the federal, state, and local levels for patient safety and quality, as well as for public health, are more easily met with computerized data because it eliminates the labor-intensive and time-consuming abstraction of data from paper records and the errors that often occur in a manual process. The Security Rule established protection for all personally identifiable health information stored in electronic format. At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented, according to estimates from two major studies. They have been estimated to result in total costs (including the expense of additional care necessitated by the errors, lost income and household productivity, and disability) of between $17 billion and $29 billion per year in hospitals nationwide. Errors also are costly in terms of loss of trust in the healthcare system by patients and diminished satisfaction by both patients and health professionals. When patients see multiple providers in different settings, none of whom has access to complete information, it becomes easier for things to go wrong. These findings were reinforced by a nationwide study revealing that one in seven Medicare patients suffered harm from hospital care, with an additional one in seven suffering temporary harm from care-related problems that were detected in time and corrected; 44 percent of these errors were found to be preventable. Accelerate integration of the best clinical knowledge into care decisions through clinical decision support. Improve continuity of care by coordination and communication within and across organizations. A study by the Center for Information Technology Leadership found more than 130,000 life-threatening situations caused by adverse drug reactions alone. The study suggested that $44 billion could be saved annually by installing computerized physician order entry systems in ambulatory settings. Leapfrog created a strategy that tied purchase of group health insurance benefits to quality care standards. Changing Society Changes in the way we live have also made paper medical records outdated. In an increasingly mobile society, patients relocate and change doctors more frequently, thus needing to transfer their medical records from previous doctors to new ones. Additionally, many patients no longer have a single general practitioner who provides their total care. Increased specialization and the development of new methods of diagnostic and preventive medicine require the ability to share exam records among different specialists and testing facilities. The Internet, one of the strongest forces for social change in the past two decades, has also affected healthcare. Consumers became accustomed to being able to access very sensitive information securely over the web. In response medical offices created interactive web sites (portals) to allow patients to view their records, make appointments, or request prescription renewals. In a number of states it is even possible for patients and doctors to conduct medical visits via the Internet. The increased capabilities of smart phones and other mobile devices to track and store heart rate and other personal fitness data as well as to link to devices that measure respiration rate, blood pressure, and blood glucose levels provide a wealth of self-generated patient health data. Strategic Framework the framework as first published listed four major goals and a corresponding set of strategies. Achievement of the eight objectives was tied to measurable outcomes, describing 43 strategies that needed to be done to achieve the objectives. Each strategy was associated with a milestone against which progress could be assessed. Technical, legal, and financial supports must be in place to enable information to flow securely to wherever it is needed to support healthcare and population health. The electronic exchange and use of health information and the enterprise integration of such information. Department of Health and Human Services, Office of National Coordinator, June 3, 2008, pp. Establishing security methods to ensure appropriate authorization and electronic authentication of health information and specifying technologies or methodologies for rendering health information unusable, unreadable, or indecipherable. Strategies to enhance the use of health information technology in improving the quality of healthcare, reducing medical errors, reducing health disparities, improving public health, increasing prevention and coordination with community resources, and improving the continuity of care among healthcare settings. Specific plans for ensuring that populations with unique needs, such as children, are appropriately addressed in the technology design, as appropriate, which may include technology that automates enrollment and retention for eligible individuals. The criteria do not preclude developers from including additional capabilities that are not required for the purposes of certification. Stage 2 began in 2014 and retained the core requirements and menu structure for meaningful use objectives established in Stage 1. Although some Stage 1 objectives were either combined or eliminated, most of the Stage 1 objectives became core objectives under the Stage 2 criteria. Stage 3, in 2016, strengthened the core objective "to protect patient health information" through the implementation of appropriate technical, administrative, and physical safeguards. The table in Figure 1-2 combines the Meaningful Use Objectives for Eligible Professionals from Stages 1, 2, and 3.
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Confidence intervals were wide in the large majority of studies blood pressure 8860 order terazosin 1 mg amex, and very few individual studies reported a statistically significant difference between intervention and control group participants heart attack zippo lighter discount 5 mg terazosin free shipping. The risk difference to experience any of the other adverse events (not gastrointestinal or infections) across treatment groups relative to control was 0 heart attack 85 year old buy discount terazosin 2mg on-line. There was no indication that the adverse event incidences were more frequent in a group using probiotic organisms arteria inflamada del corazon buy 1 mg terazosin amex. Unique Harms Generally, the identified literature was not very specific with regard to the adverse events that were monitored. The assessment and results evidence table shows, for example, that several studies analyzed blood chemistry variables, but researchers rarely reported exactly what they monitored, and none of the included studies highlighted incidences of unusual or unique results. Harms unique to probiotics were primarily infections attributed to the administered organism. Of all other included studies, only a few reported explicitly that infections, bacteremia, or sepsis incidences could possibly be attributed to the administered probiotics strain (see response to Key Question 1h). In the studies that monitored the incidence of infection, none was observed to have been caused by probiotic organisms. Some trials explicitly reported that no incidences of serious infections occurred (see Evidence Table C4, Results). Other trials reported only the number of incidences of sepsis as an adverse event, and it was not clear whether the administered probiotic strain was considered as a possible cause of the infection. The frequency of reported gastrointestinal symptoms in the existing literature is noteworthy; however, neither the quantity nor the quality is unique to probiotics intake; similar symptoms in a similar quantity were also encountered in control groups. Summary and Strength of Evidence Key Question 2 What are characteristics and associations of the reported harms in Question 1? Volume: 387 in total, but varied across subquestions and analyses Risk of bias: Medium the evidence to answer this Key Question stems from a variety of study designs and quality. Precision: Precise 54 the majority of included studies use a moderate sample sizes but studies were pooled in a meta-analysis. The identified evidence is moderate to low with regard to being able to answer the Key Question with confidence. As described, the interventions and adverse events are not well documented and studies were not designed to assess adverse events systematically. The majority of studies investigated Lactobacillus interventions, alone or in combination with other genera, most often Bifidobacterium. Studies rarely reported efforts to monitor adverse events specific to probiotic products. Hence, evaluations of the safety might change with future, more targeted, assessment of adverse events. Across all included studies, by far the most commonly reported adverse events were gastrointestinal in nature, followed by reported infections and infestations. While the case studies primarily reported infections suspected or confirmed to be caused by an administered probiotics strain, the majority of other studies reported gastrointestinal incidences. There is a lack of individual studies assessing interaction effects of medication affecting adverse events. We identified only a very small number of studies addressing acquired antibiotic resistance as a patient outcome with clinical relevance. Evidence for potential harms came from case studies in patients with multiple morbidities. Adverse events other than infections potentially caused by the administered probiotics strain and unique to probiotics were not addressed in the literature. Evidence for infections came from case studies; included trials did not report on this outcome and/or did not find any cases and did not highlight adverse events unique to probiotics use. Very few studies were identified that explicitly investigated the effects of a commercially available food product (see Evidence Table C2, Intervention). The majority of identified studies appeared to provide a probiotic intervention prepared especially for the particular research study to investigate a beneficial health effect in participants with moderate health impairments. Most included studies investigated Lactobacillus and/or Bifidobacterium preparations. Different products such as Actimel, Culturelle, Infloran, or Yakult were described. However, the majority of studies did not state any product name and reported only the genus, such as Lactobacillus, that was given to participants. By far the most common delivery vehicle was a pill or capsule, used in 101 included studies (see Evidence Table C2, Intervention). Twenty-one studies used enriched yogurt (Anukam, 2008; Bajaj, 2008; Carlsson, 2009; de Roos, 1999; Fukuda, 2008; Higashikawa, 2010; Kajimoto, 2002; Kim, 2008; Manley, 2007; MartinezCanavate, 2009; Miyaji, 2006; Olivares, 2006; Parfenov, 2005; Parfenov, 2005; Presterl, 2001; Sakamoto, 2001; Salminen, 1988; Sullivan, 2003; Tomoda, 1991; Wheeler, 1997; Xiao, 2003). Among all identified studies, 29 added probiotic organisms to an infant formula (Bin-Nun, 2005; Chouraqui, 2008; Chouraqui, 2004; Cooper, 2006; Correa, 2005; Dupont, 2010; Gibson, 2009; Haschke-Becher, 2008; Kirjavainen, 2003; Langhendries, 1995; Lin, 2008; Maldonado, 2009; Millar, 1993; Petschow, 2005; Puccio, 2007; Reuman, 1986; Ruiz-Palacios, 1996; Saavedra, 2004; Scalabrin, 2009; Stratiki, 2007; Urban, 2008; van der Aa, 2010; Vendt, 2006; Vlieger, 2009; Weizman, 2006; Weizman, 2005; Ziegler, 2003). Other studies used less common delivery vehicles such as vaginal suppositories; powder, often to be dissolved in water; chewing gum; drops; spray; or cultures on gauze pads as the Evidence Table C2, Intervention shows. Where available, we extracted the information on the delivery vehicle, such as whether the preparation was diluted with water or juice (Champagne, 2005) or mixed with breast milk (Lin, 2005). However, most studies did not describe exactly how the preparation was taken and whether it varied across participants. Only one study was identified that compared two different delivery vehicles directly (Isolauri, 1991), that is, providing direct evidence on the effect of delivery vehicles. The study reported that on day one, 58 percent of children in the milk product group vomited compared to 43 percent in the powder group; on day two, 21 percent versus 22 percent vomited; on day three, 0 versus 9 percent vomited, and after that, no more vomiting occurred. These individual study results do not allow any conclusions regarding the effects of one delivery vehicle over the other. Metaregression: Delivery Vehicle In the absence of direct comparisons, we investigated the delivery vehicle further in a meta regression. A metaregression adding the factor "delivery vehicle" to a meta-analysis model indicated that adverse events results differ by delivery vehicle based on the number of 56 participants with adverse events (p=0. The risk ratio between probiotic group participants and control group participants appeared to vary based on the chosen delivery vehicle. Hence, we investigated individual delivery vehicle further in stratified analyses. This subgroup represents the majority of included studies, as this delivery vehicle was most commonly used. We excluded all studies where the vehicle was described as a "tablet," as it was not clear from the original publication whether this was equivalent to a pill that was meant to be swallowed or a chewable tablet or a tablet that dissolves in water, for example. Yogurt/Dairy Secondly, we undertook a stratified analysis for studies that delivered the probiotic organisms in a yogurt or dairy drink. It is conceivable that probiotic organisms react to the delivery vehicle; hence participants in probiotics groups might have an increased risk of adverse events in dairy or yogurt studies. Infant formulas were excluded from this analysis in order not to add another confounder (all infant formula studies have infants as participants). However, based on the number of adverse event incidences in the 24 studies that used this delivery vehicle and reported data, the relative risk was 1. However, none of the results showed a 57 statistically significantly increased relative risk or absolute risk difference for adverse events in dairy or yogurt studies comparing treatment to control group participants. There were too few studies to investigate systematic differences between yogurt and dairy studies or to differentiate less common delivery vehicles further in a meta-analysis. Infant formula study results are presented in the response to Key Question 4d in the section on children. Overall, there was an indication that safety results may differ by delivery vehicle. However, given the type of analysis (an indirect analysis across studies), this result has to be regarded with caution and cannot replace evidence from direct, within study comparisons. In addition, chosen delivery vehicles can in part be confounded with participant characteristics. In many cases it was not reported what strains of organisms were used; only the genera, and sometimes, but not always the species, were stated. To meet inclusion criteria for the review, studies had to report a specific genus contained in the tested intervention. Genus the available research volume differs for the six investigated probiotic agents. A Lactobacillus strain was part of the intervention in 215 (68 percent) of the included studies, thereby being the most commonly studied genus. This number includes Lactobacillus strains not explicitly used as a probiotic agent but included in the product, for example as a starter culture for yogurt.
Like certain other scientists before him 5 fu arrhythmia cheap 2 mg terazosin free shipping, Wegener became impressed with the similarity in the coastlines of eastern South America and western Africa and speculated that those lands had once been joined together blood pressure medication icu purchase terazosin 5 mg with amex. In about 1910 he began toying with the idea that in the Late Paleozoic era (about 250 million years ago) all the present-day continents had formed a single large mass high blood pressure medication and lemon juice terazosin 1 mg mastercard, or supercontinent pulse pressure with age effective terazosin 1mg, which had subsequently broken apart. His term for this movement was die 252 7 Alfred Lothar Wegener 7 Verschiebung der Kontinente ("continental displacement"), which gave rise to the term continental drift. Wegener first presented his theory in lectures in 1912 and published it in full in 1915 in his most important work, Die Entstehung der Kontinente und Ozeane (The Origin of Continents and Oceans). He searched the scientific literature for geological and paleontological evidence that would buttress his theory, and he was able to point to many closely related fossil organisms and similar rock strata that occurred on widely separated continents, particularly those found in both the Americas and in Africa. By 1930 his theory had been rejected by most geologists, and it sank into obscurity for the next few decades, only to be resurrected as part of the theory of plate tectonics during the 1960s. His work on wound infection and lysozyme, an antibacterial enzyme found in tears and saliva, guaranteed him a place in the history of bacteriology. But it was his discovery of penicillin in 1928, which started the antibiotic revolution, that sealed his lasting reputation. Fleming was recognized for this achievement in 1945, when he received the Nobel Prize for Physiology or Medicine, along with Australian pathologist Howard Walter Florey and British biochemist Ernst Boris Chain, both of whom isolated and purified penicillin. At first he planned to become a surgeon, but a temporary position in the laboratories of the Inoculation Department at St. In November 1921 Fleming discovered lysozyme, an enzyme present in body fluids such as saliva and tears that has a mild antiseptic effect. It came about when he had a cold and a drop of his nasal mucus fell onto a culture plate of bacteria. Realizing that his mucus might have an effect on bacterial growth, he mixed the mucus into the culture and a few weeks later saw signs of the bacteria having been dissolved. He at first called the substance "mould juice" and then "penicillin," after the mold that produced it. Fleming decided to investigate further, because he thought that he had found an enzyme more potent than lysozyme. In fact, it was not an enzyme but an antibiotic-one of the first to be discovered. By the time Fleming had established this, he was interested in penicillin for itself. While this approach was ideal for taking advantage of a chance observation, the therapeutic development of penicillin required multidisciplinary teamwork. Fleming, working with two young researchers, failed to stabilize and purify penicillin. However, he did point out that penicillin had clinical potential, both as a topical antiseptic and as an injectable antibiotic, if it could be isolated and purified. Though Florey, his coworker Ernst Chain, and Fleming shared the Penicillium notatum, the source of penicillin. He was the first to apply the quantum concept, which restricts the energy of a system to certain discrete values, to the problem of atomic and molecular structure. His manifold roles in the origins and development of quantum physics may be his most important contribution, but through his long career his involvements were substantially broader, both inside and outside the world of physics. Only the year before, Ernest Rutherford and his collaborators at the University of Manchester had established experimentally that the atom consists of a heavy positively charged nucleus with substantially lighter negatively charged electrons circling around it at considerable distance. According to classical physics, such a system would be unstable, and Bohr felt compelled to postulate, in a substantive trilogy of articles published in the Philosophical Magazine in 1913, that electrons could only occupy particular orbits determined by the quantum of action and that electromagnetic radiation from an atom occurred only when an electron jumped to a lower-energy 256 7 Niels Bohr 7 orbit. Although radical and unacceptable to most physicists at the time, the Bohr atomic model was able to account for an ever-increasing number of experimental data, famously starting with the spectral line series emitted by hydrogen. Already in his 1913 trilogy, Bohr had sought to apply his theory to the understanding of the periodic table of elements. At the University of Copenhagen, where Bohr had established an Institute for Theoretical Physics, he improved upon this aspect of his work, developing an elaborate scheme building up the periodic table by adding electrons one after another to the atom according to his atomic model. Bohr, Heisenberg, and a few others then went on to develop what came to be known as the Copenhagen interpretation of quantum mechanics, which still provides a conceptual basis for the theory. For a complete explanation, both aspects, which according to classical physics are contradictory, need to be taken into account. The other towering figure of physics in the 20th century, Albert Einstein, never accepted the Copenhagen interpretation, famously declaring against its probabilistic implications that "God does not play dice. For the rest of his life, Bohr worked to generalize complementarity as a guiding idea applying far beyond physics. Nuclear Physics In the early 1930s Bohr, together with Hevesy and the Danish physiologist August Krogh, applied for support from the Rockefeller Foundation to build a cyclotron-a kind of particle accelerator recently invented by Ernest O. Although Bohr intended to use the cyclotron primarily for investigations in nuclear physics, it could also produce isotopes of elements involved in organic processes, making it possible in particular to extend the radioactive indicator method, invented and promoted by Hevesy, to biological purposes. By this time, at the beginning of 1939, Bohr was in the United States, where a fierce race to confirm experimentally the so-called fission of the nucleus began after the news of the German experiments and their explanation had become known. In the United States, Bohr did pathbreaking work with his younger American colleague John Archibald Wheeler at Princeton University to explain fission theoretically. The Atomic Bomb After the discovery of fission, Bohr was acutely aware of the theoretical possibility of making an atomic bomb. In early 1943 Bohr received a secret message from his British colleague James Chadwick, inviting Bohr to join him in England to do important scientific work. Convinced of the infeasibility of such a project, Bohr answered that there was greater need for him in occupied Denmark. After being warned about his imminent arrest, Bohr escaped by boat with his family across the narrow sound to Sweden. In Stockholm the invitation to England was repeated, and 259 7 the 100 Most Influential Scientists of All Time 7 Bohr was brought by a military airplane to Scotland and then on to London. Upon being briefed about the state of the Allied atomic bomb project on his arrival in London, Bohr changed his mind immediately about its feasibility. Concerned about a corresponding project being pursued in Germany, Bohr willingly joined the Allied project. He saw military service in World War I and then went to the University of Zьrich in 1921, where he remained for the next six years. There, in a six-month period in 1926, at A 260 7 Erwin Schrцdinger 7 the age of 39, a remarkably late age for original work by theoretical physicists, he produced the papers that gave the foundations of quantum wave mechanics. Adopting a proposal made by Louis de Broglie in 1924 that particles of matter have a dual nature and in some situations act like waves, Schrцdinger introduced a theory describing the behaviour of such a system by a wave equation that is now known as the Schrцdinger equation. The definite and readily visualized sequence of events of the planetary orbits of Newton is, in quantum mechanics, replaced by the more abstract notion of probability. He remained at the university until 1933, at which time he reached the decision that he could no longer live in a country in which the persecution of Jews had become a national policy. He then began a seven-year odyssey that took him to Austria, Great Britain, Belgium, the Pontifical Academy of Science in Rome, and-finally in 1940-the Dublin Institute for Advanced Studies, founded under the 261 7 the 100 Most Influential Scientists of All Time 7 influence of Premier Eamon de Valera, who had been a mathematician before turning to politics. Schrцdinger remained in Ireland for the next 15 years, doing research both in physics and in the philosophy and history of science. Although much of what Schrцdinger had to say in this book has been modified and amplified by later developments in molecular biology, his book remains one of the most useful and profound introductions to the subject. In 1956 Schrцdinger retired and returned to Vienna as professor emeritus at the university. Of all of the physicists of his generation, Schrцdinger stands out because of his extraordinary intellectual versatility. He was at home in the philosophy and literature of all of the Western languages, and his popular scientific writing in English, which he had learned as a child, is among the best of its kind. His study of ancient Greek science and philosophy, summarized in his Nature and the Greeks (1954), gave him both an admiration for the Greek invention of the scientific view of the world and a skepticism toward the relevance of science as a unique tool with which to unravel the ultimate mysteries of human existence. Because of his exceptional gifts, Schrцdinger was able in the course of his life to make significant contributions to nearly all branches of science and philosophy, an almost unique accomplishment at a time when the trend was toward increasing technical specialization in these disciplines. After the discovery of penicillin, he played a major role in initiating a calculated, systematic search for antibiotics among microbes. His consequent codiscovery of the antibiotic streptomycin, the first specific agent effective in the treatment of tuberculosis, brought him the 1952 Nobel Prize for Physiology or Medicine.
References
Duff DF, Mullins CE. Transseptal left heart catheterization in infants and children. Cathet Cardiovasc Diagn. 1978;4: 213-23.
Gronchi A, Vullo Lo S, Fiore M, et al: Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients, J Clin Oncol 27(1):24n30, 2009.
Appelt CJ, Burant CJ, Siminoff LA, Kwoh CK, Ibrahim SA. Arthritisspecific health beliefs related to aging among older male patients with knee and/or hip osteoarthritis. J Gerontol A Biol Sci Med Sci 2007; 62(2):184-90.
Kirkpatrick CH. Chronic mucocutaneous candidiasis. J Am Acad Dermatol. 1994;31(suppl 2):S14-SRoilides E, Uhlig K, Venzon D, et al. Neutrophil oxidative burst in response to blastoconidia and pseudohyphae of C. albicans: augmentation by GCSF and interferon gamma. J Infect Dis. 1992; 166:668-673.
Moser DK. Psychosocial factors and their association with clinical outcomes in patients with heart failure: why clinicians do not seem to care. Eur J Cardiovasc Nurs 2002;1:183-188.
Faberowski LW, Black S, Mickle JP. Incidence of venous air embolism during craniectomy for craniosynostosis repair. Anesthesiology. 2000;92:20-3.
Yafi FA, Duclos M, Correa JA, et al: Contemporary outcome and management of patients who had an aborted cystectomy due to unresectable bladder cancer, Urol Oncol 29(3):309n313, 2011.
