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Hurricane power outages may increase risk of carbon monoxide poisoning

(Reuters Health) – Homeowners in North Carolina and South Carolina who lost electricity in the wake of Hurricane Florence need to realize that backup generators and other temporary power sources can cause carbon monoxide poisoning, scientists warn.

People sit at a bar that has no power and drink during a “Hurricane Party” as Hurricane Florence comes ashore on Wilmington, North Carolina, September 14, 2018. REUTERS/Carlo Allegri

Portable generators, camp stoves, and charcoal camp grills can all emit enough carbon monoxide to cause severe injury and death when they’re used indoors or on porches where there isn’t enough ventilation, researchers warn in the American Journal of Public Health.

“It has been recognized `forever’ that storms and generators were a deadly combination for carbon monoxide poisoning,” said lead study author Dr. Fred Henretig, a senior toxicologist at the Poison Control Center at the Children’s Hospital of Philadelphia.

“The fix is now available, and hasn’t been instituted widely as yet,” Henretig said by email. “That fix would be new regulations to limit availability of the high-emission generators, more widespread publicity about their danger, and the news that low-emission models are now available.”

A worker restores power lines after Hurricane Florence swept through the town of Kenansville, North Carolina, U.S., September 15, 2018. REUTERS/Eduardo Munoz

Hundreds of thousands of customers, mostly in the Carolinas, were without power after Hurricane Florence hit the Southeast coast last week, and tens of thousands remain without power.

Unintended carbon monoxide poisonings predictably follow storm-related power outages of this magnitude, in large part because people can’t tell when carbon monoxide is in the air, noted Dr. Kelly Johnson-Arbor of Georgetown University School and the National Capital Poison Center in Washington, D.C.

“You can’t see it, taste it, or smell it, but it can kill you or cause long-term brain damage – it is one of the most common causes of unintentional death in the United States,” Johnson-Arbor said by email.

“Before a storm hits, it is important to make sure that your home has a working carbon monoxide detector in every sleeping area or bedroom,” Johnson-Arbor added. “Make sure you have extra batteries for the detector, because in the aftermath of a storm when the power is out for prolonged periods, carbon monoxide detectors with battery backup will lose power themselves as the batteries are used up.”

Alarms are especially important in multi-family homes and apartment complexes because carbon monoxide can pass through drywall to get from one residence to another, said Dr. Neil Hampson, an emeritus clinical professor at the University of Washington in Seattle.

People work in the reconstruction of Rodanthe pier after being partially damaged after the pass of Hurricane Florence, now downgraded to a tropical depression in Rodanthe, North Carolina, U.S., September 18, 2018. REUTERS/Eduardo Munoz

“These should provide protection against all types of residential carbon monoxide poisoning, not just that resulting from generators following storms,” Hampson, who wasn’t involved in the study, said by email.

When people use generators, they can also take steps to minimize their risk of poisoning, Hampson added.

“Solutions such as equipping generators with long power cables so that they can be operated at an appropriate distance from the home, providing a residential carbon monoxide alarm with each generator sold, fitting generators with automatic carbon monoxide-sensing shutoffs, and re-engineering generators to produce less carbon monoxide have all been proposed,” Hampson said. “As none of these have been required, generators remain a significant risk for carbon monoxide poisoning.”

People should also understand that generators are only one common cause of carbon monoxide poisoning, noted Vanya Jones of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“While this is a large proportion of the carbon monoxide exposures, more than 50 percent were caused by something else,” Jones, who wasn’t involved in the study, said by email. “Other sources of carbon monoxide poising include car exhaust and malfunctioning household appliances that use gas, and it is likely that these exposures may increase after storms too.”

SOURCE: bit.ly/2QPKsi2 American Journal of Public Health, online September 12, 2018.

Our Standards:The Thomson Reuters Trust Principles.

Bulgaria reports outbreak of virulent bird flu

SOFIA (Reuters) – An outbreak of a virulent bird flu virus has spread to a farm in southern Bulgaria, the Balkan country’s food safety agency said on Friday.

A three-kilometer protection zone was set around the farm in the village of Trilistnik, near Bulgaria’s second-largest city of Plovdiv and the sale of eggs and the movement of domestic, wild and other birds was banned within it, the agency said in a statement.

The agency said that all contaminated 43,000 hens at the farm would be culled in a humane manner.

Reporting by Angel Krasimirov; editing by Emelia Sithole-Matarise

Our Standards:The Thomson Reuters Trust Principles.

Common painkiller tied to increased risk of heart problems

(Reuters Health) – The commonly used painkiller diclofenac may be linked with an increased risk of heart problems, a large Danish study suggests.

Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) that’s often used to treat arthritis and other painful joint conditions. In many countries, it’s available without a prescription.

Researchers found that the rate of first-time cardiovascular events was 20 to 30 percent higher among people who started taking diclofenac than among people who started taking ibuprofen or naproxen, which are also NSAIDs, or paracetamol (acetaminophen). These events included heart attacks, development of an irregular heart rhythm called atrial fibrillation, or death from heart problems.

The rate of new heart problems was 50 percent higher for diclofenac users than for people who weren’t taking any painkillers.

The researchers analyzed data from the Danish national patient registry. Altogether, they had information on nearly 1.4 million diclofenac users, 3.9 million ibuprofen users, 292,000 naproxen users, 765,00 paracetamol users, and 1.3 million people not on any of these painkillers.

“It is important to note that the absolute risk for the individual patient is low,” Morten Schmidt, lead author of the study, told Reuters Health in an email.

For example, among every 400 study participants taking diclofenac, roughly one person per year had a cardiovascular event, his team calculated.

Fewer people had cardiovascular events while taking other painkillers.

Schmidt and his coauthors say there is little reason to use diclofenac before trying other NSAIDs first. The drug should not be available over the counter, they say, and when prescribed, should be accompanied by appropriate warnings about its potential risks.

The increased risk was apparent even within 30 days of starting the drug and even with low doses, the researchers reported in The BMJ.

Schmidt said diclofenac was also associated with an increased gastrointestinal bleeding risk compared with ibuprofen.

“The real question is, do these different NSAIDs carry different risks… and the study showed that modestly diclofenac appears to be worse,” David Kaufman, Director of the Slone Epidemiology Center at Boston University, who was not involved with the study, told Reuters Health by phone.

Because it wasn’t a controlled experiment, the study can’t prove that diclofenac actually caused more cardiovascular events. Still, the authors say, their study included more people than most previous analyses and provides strong evidence to guide clinical decision making.

“It is time to acknowledge the potential health risk of diclofenac and to reduce its use,” the research team concludes.

SOURCE: bit.ly/2Ck2x4G The BMJ, online September 4, 2018.

Our Standards:The Thomson Reuters Trust Principles.

Drug shortages may add $230 million to annual U.S. drug costs

(Reuters Health) – Prescription drug shortages may drive up prices twice as much as they would rise with medicines in abundant supply, adding $ 230 million a year to U.S. drug costs, a new study estimates.

Researchers examined data on 90 medications involved in shortages between December 2015 and December 2016. They compared average wholesale drug prices for 11 months before and after shortages began, and they also looked at a decade of historical price increases.

Over the 11 months preceding shortages, prices for the drugs rose an average of 7.3 percent, researchers report in the Annals of Internal Medicine. In the 11 months afterward, prices surged 16 percent on average.

“Patients exposed to out-of-pocket costs should be aware that medications may become more expensive when there is a shortage,” said lead study author Inmaculada Hernandez of the University of Pittsburgh School of Pharmacy.

Sometimes, patients who lack insurance or have bare-bones drug benefits may be able to switch to a similar drug unaffected by shortages, Hernandez said by email. But this won’t always be an option.

“The possibility of switching to alternative therapies is dependent on the medication affected, and the disease that patients take it for,” Hernandez said.

While researchers couldn’t assess the reasons behind the price increases, they did find a difference based on how many manufacturers made drugs in short supply.

When drugs were made by three or fewer companies, prices rose by an average of 12.1 percent over the 11 months preceding a shortage and by an average of 24.7 percent over the 11 months afterward, the analysis found.

By contrast, when at least four manufacturers sold the same drug, prices rose by an average of 2.5 percent over the 11 months preceding a shortage and by an average of 4.8 percent afterward.

In the 11 months after the shortage began, the expected price increase for all drugs was 20 percent compared with nine percent in the absence of a shortage, researchers calculated.

Data for the drug shortages came from U.S. Food and Drug Administration (FDA), and data on pricing came from AnalySource.

One limitation of the study is that wholesale prices don’t always reflect the final price after rebates from the manufacturers or discounts negotiated by purchasers.

Still, the findings highlight a serious public health problem that results when people can’t access or afford medications they need, said Stacie Dusetzina, a researcher at Vanderbilt University School of Medicine in Nashville, Tennessee, who wasn’t involved in the study.

“This is really a very simple case of supply and demand – if the supply is low and demand is high, the price goes up,” Dusetzina said by email.

“Some of these increases will be picked up by insurance but if patients are paying deductibles (the amount you pay before your insurance kicks in) or if they are required to pay a percentage of the price (a coinsurance) they could see their out-of-pocket spending increase,” Dusetzina added. “For patients who are uninsured, they would have to pay the full price.”

SOURCE: bit.ly/2QJ4LxD Annals of Internal Medicine, online September 17, 2018.

Our Standards:The Thomson Reuters Trust Principles.

UK doctors win battle with drug giants over cheaper eye medicine

ZURICH (Reuters) – Drug giants Novartis, Bayer and Roche on Friday lost a bid to stop British doctors from recommending a cheaper drug option for people with an eye disease that causes blindness, the High Court in London ruled.

A drug industry group said the decision was “extraordinary” and was bad news for future regulatory cooperation between Britain and the European Union after Britain’s exit from the bloc next year.

The companies had sought to block doctors from 12 health groups in the north of England from making Roche’s cancer therapy Avastin the preferred option for wet age-related macular degeneration (AMD), even though it is not licensed for this use.

Avastin works similarly to Bayer’s Eylea and Roche’s and Novartis’s Lucentis, but those drugs were made specifically for the eye.

“Treating clinicians can lawfully choose Avastin for opthalmic use on grounds of cost,” according to the ruling. It added that NICE, the UK’s drug cost effectiveness agency, had concluded that using Avastin for AMD was safe.

Avastin costs around 28 pounds ($ 37) per injection, according to the judgment, while Eylea costs around 816 pounds per injection and Lucentis costs around 551 pounds per injection. The actual prices vary, however, based on confidential discounts.

Bayer said it was disappointed, adding the ruling puts up roadblocks for companies trying to develop new medicines if off-label uses of older drugs win official sanction.

“Bayer is currently considering all of its options, including the possibility of an appeal,” it said.

While Roche makes Avastin, it wants to sell the more expensive Lucentis for eye patients and said prescribing medicines for off-label use merely based on cost was illegal.

“We believe the unapproved use of medicines for purely economic reasons breaches established laws governing the unapproved or unlicensed use of medicines,” according to a statement from the Basel-based company.  

UK drug industry lobby ABPI said it would examine the ruling carefully. “This extraordinary judgment potentially undermines the regulation of all medicines and by doing that, neither patients nor doctors have clarity on what information to trust.”

Eylea and Lucentis, like Avastin, reduce new blood vessel growth that contributes to AMD, which occurs when the macula is unable to function properly.

Bayer and Novartis have argued Avastin had not undergone the same regulatory scrutiny for use in AMD as Lucentis and Eylea.

The doctors group has said using Avastin rather than Eylea or Lucentis could save the regional National Health Service (NHS) 13.5 million pounds a year. Across England, savings from using Avastin could total more than 500 million pounds, the British Medical Journal has reported.

According to the policy sought by the doctors, patients will be told Avastin is the preferred choice, although they are still free to choose Eylea or Lucentis.

($ 1 = 0.7606 pounds)($ 1 = 0.8516 euros)

Reporting by John Miller in Zurich, Kate Kelland in London and Ludwig Burger in Frankfurt

Our Standards:The Thomson Reuters Trust Principles.

Warm Autumn Chicken and Rice Bowls

courtesy of Audra Fullerton

Recipe Is:


How to Make It

Step 1

Preheat oven to 425°F. Combine rice, water, and a generous pinch of salt in a medium saucepan. Bring to a boil. Lower heat to maintain a steady simmer, cover, and cook until grains are tender and some have burst open, 45 to 50 minutes.

Step 2

Slice squash in half lengthwise, and scoop out seeds. Slice crosswise into 1/2-inch thick crescents. Toss squash and brussels sprouts with the oil, and season with salt and pepper. Arrange in a single layer on a rimmed baking sheet. Roast until tender, 20 to 25 minutes, stirring sprouts and flipping squash halfway through.

Step 3

Meanwhile, add chicken and ginger to a large saucepan in a single layer, and cover with cool water by 2 inches. Bring to a boil, then reduce the heat to low, and simmer until chicken is cooked through, 10 to 12 minutes. Transfer chicken to a cutting board, and shred meat with two forks.

Step 4

For sauce, place all ingredients in bowl of a food processor or blender, and process continuously until well combined. Thin with water, if desired.

Step 5

To serve, divide rice among 4 bowls. Top with shredded chicken, squash, brussels sprouts, and arugula. Drizzle with sauce, and garnish with pumpkin and pomegranate seeds, if desired.

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'Heat-not-burn' cigarettes still damage lungs

(Reuters Health) – A new type of “heat-not-burn” cigarette may lead to just as much lung damage as traditional cigarettes, a recent study suggests.

So-called “heat-not-burn” devices are designed to heat disposable tobacco sticks and give users the taste of tobacco without the smoke or ash.

For the study, researchers analyzed data submitted by Philip Morris International to the U.S. Food and Drug Administration when the company was trying to win regulatory approval to market its I-Quit-Ordinary Smoking (IQOS) product as a safer alternative to traditional cigarettes.

The FDA has yet to weigh in on whether Philip Morris can sell its IQOS device as a lower-risk cigarette alternative. But an expert scientific panel convened by the FDA recommended against such a move earlier this year, and the new study offers fresh evidence of health risks associated with IQOS.

When smokers switched from traditional cigarettes to “heat-not-burn” devices, researchers didn’t find any evidence of improvements in lung function or reductions in inflammation that can signal tobacco-related blood vessel damage.

“Even if a patient could switch completely from regular cigarettes to heat-not-burn products, Philip Morris International’s own data shows that there will continue to be significant health risks associated with these products,” said lead study author Dr. Farzad Moazed of the University of California, San Francisco.

“Although quitting smoking is challenging, there are many other options for smoking cessation that are more effective and safer than the use of these products,” Moazed said by email.

There is evidence that IQOS may reduce exposure to certain harmful chemicals, Moazed said, a point Philip Morris emphasized in a statement released after the FDA advisory panel decision. (bit.ly/2O0S42z)

Philip Morris also disputed the study authors’ conclusions.

“The totality of evidence available on IQOS supports that it is likely to present less risk of harm compared to continued smoking,” Philip Morris said in an emailed statement to Reuters Health. “This includes a significant reduction in inflammatory response and favorable changes in lung function.” (bit.ly/2QPuiVF)

“Heated tobacco products, also known as heat-not-burn products, generate a nicotine aerosol by heating sticks made up of tobacco and other chemicals without lighting them on fire,” Moazed said. “While this reduces the amount of some of the harmful chemicals associated with smoking, it increases the levels of other chemicals, and the evidence to date shows that these products continue to result in harm.”

While there’s limited data on the safety of IQOS relative to traditional cigarettes, and no long-term studies, the available evidence suggests that the devices are just as harmful to the lungs and immune system as traditional cigarettes, Moazed’s team concludes in Tobacco Control.

It’s also unclear from research to date whether IQOS might help smokers quit, a factor that might influence how scientists think about the safety of these devices and other tobacco products sold as alternatives to traditional cigarettes.

The human studies Philip Morris submitted to the FDA excluded people who were “dual users” of both traditional cigarettes and IQOS devices, the study authors note.

Any safety advantage relative to traditional cigarettes might be diminished if people continue to smoke traditional cigarettes once they start using IQOS devices, said Bonnie Halpern-Felsher, a tobacco prevention researcher at Stanford University School of Medicine in Palo Alto, California, who wasn’t involved in the study.

“We have no studies outside of Philip Morris on whether these IQOS will actually help people quit or on their relative safety,” Halpern-Felsher added. “People are unlikely to understand what “switching completely” means and that therefore they are likely to be misled,” by any safety claims that are contingent on smoking cessation.

SOURCE: bit.ly/2NVTxXY Tobacco Control, online August 27, 2018.

Our Standards:The Thomson Reuters Trust Principles.

U.S. agency accuses Walmart of pregnancy discrimination in lawsuit

(Reuters) – The U.S. Equal Employment Opportunity Commission on Friday filed a lawsuit accusing Walmart Inc of forcing pregnant workers at a Wisconsin warehouse to go on unpaid leave and denying their requests to take on easier duties.

FILE PHOTO: The logo of Walmart is seen outside of a new Walmart Store in San Salvador, El Salvador, August 21, 2018. REUTERS/Jose Cabezas/File Photo

The EEOC, which enforces federal laws banning discrimination in the workplace, said Walmart’s distribution center in Menomonie, Wisconsin, has discriminated against pregnant employees since 2014. Federal law requires employers to accommodate workers’ pregnancies in the same way as physical disabilities.

Arkansas-based Walmart, the largest U.S. retailer, did not immediately respond to a request for comment.

The lawsuit, filed in federal court in Wisconsin, stems from a complaint filed by Walmart employee Alyssa Gilliam.

The EEOC in the lawsuit said Gilliam became pregnant in 2015, and Walmart denied her requests for restrictions on heavy lifting, additional breaks, and a chair to sit in while working.

The commission said Walmart refused similar requests by other pregnant workers at the warehouse, but granted them for workers with disabilities or injuries.

The federal Pregnancy Discrimination Act prohibits workplace discrimination against pregnant women. In a 2015 decision, the U.S. Supreme Court said the law requires employers to provide the same accommodations to pregnant women as it does disabled workers.

Reporting by Daniel Wiessner in Albany, New York; Editing by Chizu Nomiyama and Bill Berkrot

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Congo confirms Ebola case at Ugandan border

GOMA, Democratic Republic of Congo (Reuters) – Democratic Republic of Congo has confirmed a case of Ebola on its border with Uganda, a country so far clear of the deadly virus, authorities in Congo said on Friday.

A medical worker wears a protective suit as he prepares to administer Ebola patient care at The Alliance for International Medical Action (ALIMA) treatment center in Beni, North Kivu province of the Democratic Republic of Congo September 6, 2018. REUTERS/Fiston Mahamba

The new infection is almost 200 km (125 miles) away from the nearest other known case in Congo’s current Ebola outbreak, which is believed to have killed 97 people since July and infected another 46 in North Kivu and Ituri provinces.

Ituri province’s Vice Governor Keta Upar said in a statement that the latest Ebola case had been reported in Tchomia on the shores of Lake Albert. It is the closest the disease has come to Uganda, Congo’s eastern neighbor.

Uganda’s health ministry said on Thursday it was preparing to deploy vaccinations against the virus should it spread to its territory.

Congo has experienced 10 outbreaks of Ebola since it was discovered in the country’s forested north in 1976. The disease causes hemorrhagic fever, vomiting and diarrhea and kills about half of the people it infects.

Health officials have made progress slowing the spread of the virus with experimental vaccines and treatments. But violence and turmoil in eastern Congo has made some areas difficult to access.

Dozens have been killed in ethnic clashes between groups in Djugu territory where Tchomia is located, with thousands crossing into Uganda to escape the violence.

Reporting by Fiston Mahamba; additional reporting by Stephanie Ulmer-Nebehay in Geneva; writing by Sofia Christensen; editing by Edward McAllister and Andrew Roche

Our Standards:The Thomson Reuters Trust Principles.

Congo confirms Ebola case at border crossing point on Lake Albert

GOMA, Democratic Republic of Congo (Reuters) – Democratic Republic of Congo has confirmed a case of Ebola on the shores of Lake Albert at a border point where people can cross into Uganda and almost 200 km (125 miles) away from the nearest other case, Ituri province’s vice governor said on Friday.

A medical worker wears a protective suit as he prepares to administer Ebola patient care at The Alliance for International Medical Action (ALIMA) treatment center in Beni, North Kivu province of the Democratic Republic of Congo September 6, 2018. REUTERS/Fiston Mahamba

The current Ebola outbreak, which was declared on Aug. 1, is believed to have killed 97 people since July and infected another 46 in North Kivu and Ituri provinces.

Reporting by Fiston Mahamba; Writing by Sofia Christensen; Editing by Aaron Ross

Our Standards:The Thomson Reuters Trust Principles.