Nearly 5 million Americans have heart failure today, with an incidence approaching 10 per 1000 population among persons older than 65 years of age. Heart failure is the reason for at least 20 percent of all hospital admissions among persons older than 65. Over the past decade, the rate of hospitalizations for heart failure has increased by 159 percent. 2 In 1997, an estimated $5,501 was spent for every hospital-discharge diagnosis of heart failure, and another $1,742 per month was required to care for each patient after discharge. Accordingly, substantial efforts have been made to identify and treat the factors that predict recurrent hospitalization. End points of large randomized trials now include the effect of the studied intervention on the rate of hospital admissions. For example, angiotensin-converting–enzyme (ACE) inhibitors, angiotensin-receptor antagonists, beta-blockers, spironolactone, biventricular pacing, coronary bypass surgery, and the use of multidisciplinary teams to treat heart failure have all been shown to reduce the rate of hospitalizations substantially, as well as to reduce mortality or improve functional status. 3-5 Considerable debate has focused on the mechanisms that reduce the rate of admissions and on the type of physician who should care for patients with heart failure. In the United States, more than two thirds of patients with heart failure are cared for exclusively by primary care practitioners. Multiple clinical trials completed during the past 15 years have unequivocally shown a substantial reduction in mortality for patients with systolic heart failure. Simultaneously, however, large epidemiologic surveys, such as the ongoing Framingham Study, have not documented any meaningful change in overall death rates. (Death seems to have been delayed, however, and occurs a longer time after major cardiac events such as a myocardial infarction.) Symptomatic heart failure continues to confer a worse prognosis than the majority of cancers in this country, with one-year mortality of approximately 45 percent. 6,7 Why have the newer and successful therapies failed to result in a meaningful reduction in mortality due to heart failure? It is important to recognize that heart failure is a clinical syndrome arising from diverse causes. Not all patients with the condition have poorly contracting ventricles and a low ejection fraction. Many have uncorrected valvular disease, such as aortic stenosis or mitral regurgitation, or abnormal filling, resulting in diastolic heart failure. A large majority of patients with heart failure are elderly, and 75 percent of patients have a history of hypertension. Many patients have at least one serious coexisting condition, in addition to advanced age. Such patients have not usually been subjects in investigational trials. Moreover, until recently, the majority of patients entered into trials of investigational drugs were middle-aged white men with heart failure due to ischemic cardiomyopathy. Fewer women and members of racial minorities have taken part in trials, and very few trials have included persons older than 75 years of age. Thus, despite the acknowledgedsuccesses of the therapies outlined below, there is much to be done in the prevention and management of heart failure in the large subgroups of patients who are not well represented in trials. Certainly, successful treatments have not been systematically applied to the majority of patients with heart failure, and for the reasons stated above, those that have been applied may not be efficacious. Although heart failure is a major public health problem, there are no national screening efforts to detect the disease at its earlier stages, as there are for breast and prostate cancer or even osteoporosis. Heart failure is largely preventable, primarily through the control of blood pressure and other vascular risk factors. Yet, until recently, the factors that render a patient at high risk for heart failure had not been clearly defined or publicized. The guidelines for the evaluation and management of chronic heart failure that were published recently by the American College of Cardiology and the American Heart Association have corrected this deficit. 8 The writing committee developed a new approach to the classification of heart failure that emphasizes its evolution and progression and defined four stages of heart failure. Patients with stage A heart failure are at high risk for the development of heart failure but have no apparent structural abnormality of the heart. Patients with stage B heart failure have a structural abnormality of the heart but have never had symptoms of heart failure. Patients with stage C heart failure have a structural abnormality of the heart and current or previous symptoms of heart failure. Patients with stage D heart failure have endstage symptoms of heart failure that are refractory to standard treatment. This staged classification underscores the fact that established risk factors and structural abnormalities are necessary for the development of heart failure, recognizes its progressive nature, and superimposes treatment strategies on the fundamentals of preventive efforts. The classification is a departure from the traditional New York Heart Association (NYHA) classification, which has primarily been used as shorthand to describe functional limitations. 9 Heart failure may progress from stage A to stage D in a given patient but cannot follow the path in reverse. In contrast, a patient with NYHA class IV symptoms might have quick improvement to class III with diuretic therapy alone. This staged heartfailure classification promotes a way of thinking about heart failure that is similar to our way of thinking about cancer — that is, the identification and screening of patients who are at risk, patients with in situ disease, and patients with established or widespread disease. The ensuing discussion about the treatment of heart failure is keyed toward this new staging classification. Read the rest of this entry »
“Overheat”
Untuk mesin modern yang sudah dilengkapi komputer, bila beroperasi melebihi batas suhu kerja, maka komputer otomatis akan melindungi dengan cara menonaktifkan mesin secara bertahap. Misalnya, komputer akan menghentikan kerja kompresor AC, berlanjut ke mode aman (safe mode), hingga saatnya mesin dihentikan secara total.
Namun, mesin era 1990-an belum dilengkapi komputer. Gejala overheat bisa dideteksi dengan munculnya gejala knocking saat berakselerasi.
* Langkah preventif
Periksa cooling system dan jumlah oli mesin secara berkala. Perhatikan indikator suhu mesin saat timbul knocking, dan segera tepikan mobil.
Kebocoran oli
Berkurangnya jumlah oli mesin secara drastis akan menyebabkan friksi pada komponen yang bergerak. Dampaknya,suhu mesin tinggi (overheat) dan keausan luar biasa. Penyebabnya adalah kerusakan pada baut penutup lubang pembuangan oli akibat terkena hantaman benda keras, atau kondisi sil-sil di mesin kurang bagus. Perlu juga cermati indikator oli di dasbor yang akan menyala bila kekurangan pelumas.
* Langkah preventif
Periksa oli secara berkala. Jangan menganggap remeh indikator oli yang menyala. Itu menandakan bahwa pompa oli kehilangan tekanan.
“Water hammer”
Air tersedot ke ruang bakar akibat menerjang genangan air yang tinggi. Air yang jauh lebih padat dari udara, sampai memenuhi ruang bakar, tentu tidak dapat tekanan saat mesin bekerja pada langkah kompresi. Dalam kondisi katup tertutup, tekanan air akan menghancurkan komponen terlemah di ruang bakar, yakni piston.
* Langkah preventif
Ketahui ketinggian saluran masuk udara di mesin. Jangan sekali-sekali menstarter ketika mesin mati di tengah banjir. Buka busi, lalu start mesin untuk mengeluarkan air di ruang bakar.
“Timing belt”
Fungsinya sebagai penyelaras putaran kruk as dan katup sehingga keduanya tidak berbenturan. Namun, fatal akibatnya bila belt yang menghubungkan kedua mekanisme ini putus secara tiba-tiba. Kerusakan tak terelakkan lantaran piston akan menumbuk katup yang berada dalam posisi membuka.
Bila hal tersebut terjadi dalam putaran mesin tinggi, maka blok mesin bisa pecah. Kondisi ini bisa diminimalkan bila Anda tahu kerusakan yang terjadi. Mesin dengan perbandingan kompresi rendah atau yang dilengkapi turbocharger atau supercharger cenderung memiliki peluang lebih kecil terhadap kerusakan.
# Hindari memanaskan mesin terlalu lama sebelum berkendara. Selama mesin bekerja maka bahan bakar tetap terkirim, sehingga banyak BBM yang terbuang sia-sia.
# Pertahankan kecepatan kendaraan sedapat mungkin sekitar 70 ~ 80 km/jam atau RPM di bawah 3000.
# Hindari kecepatan tinggi yang tidak perlu semakin tinggi kecepatan sebanding dengan tingginya putaran mesin sehingga bahan bakar minyak yang harus dikirimpun semakin besar.
# Sesuaikan gigi percepatan dengan kecepatan kendaraan, gunakan gigi rendah untuk menjalankan kendaraan pertama kali.
Contoh: Gigi 1 Kecepatan 0-20 km/jam
Gigi 2 Kecepatan 20-40 km/jam
Gigi 3 Kecepatan 40-60 km/jam
Gigi 4 Kecepatan 60-90 km/jam
Gigi 5 Kecepatan 90 ~ km/jam
# Lakukan akselerasi/penekanan pedal gas secara perlahan (bertahap), jangan melakukan secara tiba-tiba karena dapat mengakibatkan terjadinya penambahan bahan bakar secara berlebihan.
# Hindari muatan yang berlebihan. Untuk membawa beban yang besar dibutuhkan tenaga yang besar yang berarti bahan bakar yang seimbang.
# Matikan mesin saat kendaraan berhenti dalam waktu lama (parkir).
# Aktifkan penyejuk udara (AC) dengan temperatur yang tidak terlalu rendah. Hal ini akan membuat kerja kompresor tidak terlalu lama (atau matikan bila perlu).
# Jangan meletakkan kaki kiri pada pedal kopling saat berkendara atau berkendara dengan setengah kopling. Ini akan mengakibatkan tenaga mesin tidak sepenuhnya tersalurkan untuk menggerakkan kendaraan.
# Gunakan bahan bakar sesuai nilai oktan yang disarankan oleh produsen. Nilai oktan bahan bakar akan menentukan pembakaran yang sempurna, sehingga sangat berpengaruh terhadap tenaga yang dihasilkan oleh mesin.
# Gunakan ban dengan kembang dan tekanan angin yang tepat.
WASHINGTON, June 19, 2009 (Reuters) — The new strain of H1N1 flu is causing “something different” to happen in the United States this year — perhaps an extended year-round flu season that disproportionately hits young people, health officials said on Thursday.
An unusually cool late spring may be helping keep the infection going in the U.S. Northeast, especially densely populated areas in New York and Massachusetts, the officials at the U.S. Centers for Disease Control and Prevention said.
And infections among healthcare workers suggest that people are showing up at work sick — meaning that workplace policies may be contributing to its spread, the CDC officials said. Read the rest of this entry »
“On the highest point of the mountain is a mound of earth, forming an altar of Zeus Lykaios, and from it most of the Peloponnesos can be seen,” wrote Pausanias, in his famous, well-respected multi-volume Description of Greece. “Before the altar on the east stand two pillars, on which there were of old gilded eagles. On this altar they sacrifice in secret to Lykaion Zeus. I was reluctant to pry into the details of the sacrifice; let them be as they are and were from the beginning.”
What would surprise Pausanias—as it is surprising archaeologists—is how early that “beginning” actually may be. New pottery evidence from excavations by the Greek-American, interdisciplinary team of the Mt. Lykaion Excavation and Survey Project indicates that the ash altar—a cone of earth located atop the southern peak of Mt Lykaion where dedications were made in antiquity— was in use as early as 5,000 years ago—at least 1,000 years before the early Greeks began to worship the god Zeus. Read the rest of this entry »
First off to wow us with its long-rumoured but never-confirmed motion control system was Microsoft’s Project Natal. Natal allows a person to act as their own controller, with a depth-perceptive camera capturing the user’s movements and then translating them into actions on-screen. Signing into your account with Natal is also easier, with facial recognition allowing the Xbox to recognise you. With his Xbox Avatar mimicking his every movement while browsing through the Xbox 360’s Dashboard, Kudo Tsunoda used flicks and stabs of his hand to move between screens and select different items, explaining how Project Natal captured a user’s entire body. Read the rest of this entry »
An Earth-like planet spotted outside our solar system is the first found that could support liquid water and harbor life, scientists announced today.
Liquid water is a key ingredient for life as we know it. The newfound planet is located at the “Goldilocks” distance-not too close and not too far from its star to keep water on its surface from freezing or vaporizing away.
And while astronomers are not yet able to look for signs of biology on the planet, the discovery is a milestone in planet detection and the search for extraterrestrial life, one with the potential to profoundly change our outlook on the universe.
“The goal is to find life on a planet like the Earth around a star like the Sun. This is a step in that direction,” said study leader Stephane Udry of the Geneva Observatory in Switzerland. “Each time you go one step forward you are very happy.”
The new planet is about 50 percent bigger than Earth and about five times more massive. The new “super-Earth” is called Gliese 581 C, after its star, Gliese 581, a diminutive red dwarf star located 20.5 light-years away that is about one-third as massive as the Sun.
Smallest to date
Gliese 581 C is the smallest extrasolar planet, or “exoplanet,” discovered to date. It is located about 15 times closer to its star than Earth is to the Sun; one year on the planet is equal to 13 Earth days. Because red dwarfs, also known as M dwarfs, are about 50 times dimmer than the Sun and much cooler, their planets can orbit much closer to them while still remaining within their habitable zones, the spherical region around a star within which a planet’s temperature can sustain liquid water on its surface.
Because it lies within its star’s habitable zone and is relatively close to Earth, Gliese 581 C could be a very important target for future space missions dedicated to the search for extraterrestrial life, said study team member Xavier Delfosse of Grenoble University in France.
“On the treasure map of the universe, one would be tempted to mark this planet with an X,” Delfosse said.
Two other planets are known to inhabit the red dwarf system. One is a 15 Earth-mass “hot-Jupiter” gas planet discovered by the same team two years ago, which orbits even closer to its star than does Gliese 581 C. Another is an 8 Earth-mass planet discovered at the same time as Gliese 581 C, but which lies outside its star’s habitable zone.
Possible waterworld
Computer models predict Gliese 581 C is either a rocky planet like Earth or a waterworld covered entirely by oceans.
“We have estimated that the mean temperature of this super-Earth lies between 0 and 40 degrees Celsius [32 to 104 degrees Fahrenheit], and water would thus be liquid,” Udry said.
The scientists discovered the new world using the HARP instrument on the European Southern Observatory 3.6 meter telescope in La Sille, Chile. They employed the so-called radial velocity, or “wobble,” technique, in which the size and mass of a planet are determined based on small perturbations it induces in its parent star’s orbit via gravity.
Udry said there was a fair amount of time between the calculation of Gliese 581 C’s size and the realization it was within its star’s habitable zone. “That came at the end,” Udry said.
When it did hit him, Udry knew he would be spending time fielding phone calls from the media. “You right away think about the journalists who will like it very much.
More to come
David Charbonneau, an astronomer at the Harvard-Smithsonian Center for Astrophysics (CfA) who was not involved in the study, said the new finding is an “absolutely fantastic discovery.”
“It means there probably are many more such planets out there,” Charbonneau said in a telephone interview. Whether Gliese 581 C harbors life is still unknown, but “it satisfies for the first time a key requirement.”
Charbonneau also praised the team’s technical skills. “The wobble induced on the star by each of these planets is really tiny-it’s just a few meters a second. That means their measurement precision is exquisite,” he said.
David Latham, another astronomer at Harvard-Smithsonian CfA, echoed other scientists’ praise of the discovery but said the next step is to find a similar world where the orbit of the habitable planet carries it between Earth and its parent star. This will allow scientists to observe it using the transit technique, whereby the small dimming starlight caused by the planet’s passage across the face of its sun can be used to calculate its size.
Only then can scientists determine for certain whether the world is rocky or covered by water, Latham said.
Alan Boss, a planetary theorist at the Carnegie Institution of Washington, said the new planet’s potential for liquid water made it “fascinating.” Gliese 581 C “is the closest planet to another Earth that has been found to date. I hope the SETI folks are listening,” Boss said.
Seth Shostak, a senior astronomer at the SETI institute, said the Gliese 581 system has in fact been looked at twice before for signs of intelligent life. The first time was in 1995 using the Parkes Radio Telescope in Australia; the second time occured in 1997 using the 140-foot telescope in Greenbank,West Virgina. Both times revealed nothing.
“It has been looked at twice, but that doesn’t mean we shouldn’t look at it again,” Shostak said. “And indeed we should because this is the best candidate the extrasolar planet guys have come up with yet.”
Shostak said he was “jazzed” by the discovery. “This is pointing to something that in the past has only been an assumption, namely that Earth-sized worlds are not rare,” he said. “We know of only two [planets in the habitable zone]. We know this one and we know our own. But two is better than one.”
Shostak said the Gliese 581 system will likely be looked at again over much wider range of the radio spectrum when the new Allen Telescope Array begins operations this summer.
Para dokter di National Taiwan Hospital baru-baru ini mengejutkan dunia kedokteran karena ditemukannya kasus seorang dokter muda berusia 37 tahun yang selama ini sangat mempercayai hasil pemeriksaan fungsi hati (GOT, GPT), tetapi ternyata saat menjelang Hari Raya Imlek diketahui positif menderita kanker hati sepanjang 10 cm!
Selama ini hampir semua orang sangat bergantung pada hasil indeks
pemeriksaan fungsi hati (Liver Function Index). Mereka menganggap bila
pemeriksaan menunjukkan hasil index yang normal berarti semua OK.
Kesalahpahaman macam ini ternyata juga dilakukan oleh banyak dokter
spesialis. Benar-benar mengejutkan, para dokter yang seharusnya
memberikan pengetahuan yang benar pada masyarakat umum, ternyata
memiliki pengetahuan yang tidak benar. Pencegahan kanker hati harus
dilakukan dengan cara yang benar. Tidak ada jalan lain kecuali
mendeteksi dan mengobatinya sedini mungkin, demikian kata dokter Hsu
Chin Ch’uan. Tetapi ironisnya, ternyata dokter yang menangani kanker
hati juga bisa memiliki pandangan yang salah, bahkan menyesatkan
masyarakat, inilah penyebab terbesar kenapa kanker hati sulit untuk
disembuhkan. Read the rest of this entry »
London, UK – 6th November 2007 – Sony Ericsson today revealed the two latest additions to its Walkman® phone portfolio. The W890 and W380 Walkman® phones are stylish new offerings packed with features sure to set music lovers’ pulses racing.
* With its super slim, stylish design, massive 2GB music storage capacity, and 3.2 megapixel camera, the W890 Walkman® phone promises to hit the right notes with sophisticated music lovers and design connoisseurs alike.
* For the music fan on the move, the W380 Walkman® phone combines a unique clamshell design with all the music cred users expect from Sony Ericsson’s Walkman® phones. The phone packs in never-seen before features, including Gesture control which allows users to mute calls with a wave of their hands. There is also an external display that comes to life only when you need it; to show the name of a music track or to let you know who is calling.
“With these latest phones, we address the needs of young, fashion-conscious music lovers with the W380, as well as music connoisseurs who demand the latest Walkman® features and fast downloads offered by the W890,” says Ben Padley, Head of Music Marketing at Sony Ericsson. “These Walkman® phones combine Sony Ericsson’s undeniable expertise in mobile communications and mobile music to stunning effect.” Read the rest of this entry »
Pidato Obama di Kairo ditanggapi dengan baik oleh berbagai pihak media, yang dinanti sekarang adalah proses perdamaian Timur Tengah.
Harian Jerman Tagesspiegel yang terbit di Berlin menulis:
Di Kairo Obama memberi pidato yang kuat dan bernuansa. Dengan meyakinkan ia memberi uluran tangan. Memang ada harapan cukup tinggi sebelum pidato itu. Antara lain karena asal-usul Obama sendiri, biografinya dan janji-janji politiknya. Hubungan kompleks antara Amerika Serikat dan dunia Islam tentu tidak bisa diperbaiki hanya dalam satu hari saja. Namun penampilan Obama di Kairo telah memberi impuls penting. Read the rest of this entry »