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[ { "answer_id": 29367, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 3, "selected": false, "text": "<p>The <a href=\"https://www.rxlist.com/adderall_vs_ritalin/drugs-condition.htm\" rel=\"noreferrer\">Adderall vs. Ritalin page on Rx List</a> gives the answer.</p>\n<blockquote>\n<p>Both Adderall (amphetamine and dextroamphetamine) and Ritalin (methylphenidate) are central nervous system stimulants used to treat attention deficit hyperactivity disorder [ADHD].</p>\n<p>Methylphenidate (also sold as Concerta) isn't an amphetamine and its effects tend to be milder than those of Adderall. Patients also report a more pronounced effect on cognitive function and thought processes when taking Ritalin as opposed to Adderall, which comes with a number of effects on the body such as increased heart rate and others.</p>\n</blockquote>\n<p>I would imagine that the reason for it to be banned in chess is that</p>\n<blockquote>\n<p>Ritalin may help increase attention and decrease impulsiveness.</p>\n</blockquote>\n<p>Therefore, it could potentially create an unfair advantage to those who are under the influence.</p>\n<p>However, the World Anti Doping Agency (WADA) do have <a href=\"https://www.wada-ama.org/en/what-we-do/science-medical/therapeutic-use-exemptions\" rel=\"noreferrer\">Therapeutic Use Exemptions (TUEs)</a>. This allows those suffering from ADHD for example, to continue their medication therapy as long as they satisfy strict criteria. (See <a href=\"https://www.usada.org/spirit-of-sport/education/athletes-adhd-know-about-tues/\" rel=\"noreferrer\">the USADA webpage</a> for more)</p>\n<blockquote>\n<p>Athletes with ADHD can continue using necessary prohibited stimulant medications while competing in sanctioned sports as long as they receive a Therapeutic Use Exemption (TUE), which requires them to demonstrate that they can satisfy strict criteria for TUE approval.</p>\n</blockquote>\n" }, { "answer_id": 30518, "author": "electronpusher", "author_id": 7757, "author_profile": "https://health.stackexchange.com/users/7757", "pm_score": 3, "selected": true, "text": "<p>I agree that the regulation is worded inappropriately, and that methylphenidate is not an amphetamine. However, I would like to provide a more thorough answer than &quot;rxlist.com says so&quot;. We'll have to borrow a few ideas from organic chemistry.</p>\n<p><em>Amphetamine</em> is a substance with a specific molecular structure, shown below (under the title &quot;Adderall&quot;), and <em>an amphetamine</em> is any of many substances with molecular structures based on that of amphetamine (examples in the second image). You can think of amphetamine as the parent structure of a class of substances which are called <em>substituted amphetamines</em> or simply <em>amphetamines</em>. For instance, if the group of atoms circled in blue on the methylphenidate structure was placed on the amphetamine structure, you would have a substituted amphetamine (&quot;an amphetamine&quot;).</p>\n<p><a href=\"https://i.stack.imgur.com/hRYSs.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/hRYSs.jpg\" alt=\"enter image description here\" /></a></p>\n<p>Methamphetamine, MDMA, ephedrine, methylephedrine and pseudoephedrine are also amphetamines in this sense. I've highlighted in green groups that are added to <em>amphetamine</em> to produce some of these <em>amphetamines</em>.</p>\n<p><a href=\"https://i.stack.imgur.com/1U4iu.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/1U4iu.jpg\" alt=\"enter image description here\" /></a></p>\n<p>So, why isn't methylphenidate an amphetamine? The blue group doesn't make a difference, because adding it to amphetamine would just produce a substituted amphetamine. It is the group of atoms circled in red that matter. You see, <em>amphetamine</em> is a portmanteau of <em><strong>a</strong>lpha-<strong>m</strong>ethyl<strong>ph</strong>en<strong>et</strong>hyl<strong>amine</strong></em>, which signifies that amphetamine is a <em>phenethylamine</em> molecule with a <em>methyl group</em> (CH3) in the <em>alpha</em> location, as depicted below. (Phenethylamines are an interesting class of molecules in their own right, including many drugs and neurotransmitters such as dopamine, norepinephrine and adrenaline.)</p>\n<p><a href=\"https://i.stack.imgur.com/rK8w5.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/rK8w5.jpg\" alt=\"enter image description here\" /></a></p>\n<p>The group in the alpha position is crucial to our question. If the group at the alpha position is not CH3, then the molecule is not an amphetamine. In methylphenidate, the group in the alpha position (circled in red) is a chain of four carbon atoms (and their associated hydrogens) which may be represented as CH2-CH2-CH2-CH2 (and happens to connect to the N atom at the far end, though this doesn't matter for our purposes). Since methylphenidate has a 4-carbon chain in the alpha position of its molecular structure, it cannot be called an <strong>am</strong>phetamine, because as mentioned in the previous paragraph the <strong>am</strong> implies there is a 1-carbon (<strong>m</strong>ethyl) group in the <strong>a</strong>lpha position.</p>\n<p><a href=\"https://i.stack.imgur.com/hRYSs.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/hRYSs.jpg\" alt=\"enter image description here\" /></a></p>\n<p>Despite this, methylphenidate and amphetamine do have a lot in common. They both belong to the <em>functional</em> class of CNS stimulants, as the OP and the other answerer are aware. In addition, methylphenidate and amphetamine do both belong to a common <em>structural</em> class, which is the phenethylamine class. That is to say, both methylphenidate and amphetamine are (substituted) phenethylamines.</p>\n<p>Therefore, one way in which the chess WADA policy could be reworded is:</p>\n<blockquote>\n<p><strong>Phenethylamine Stimulants</strong> - Ritalin or amphetamines such as\nAdderall, ephedrine, pseudoephedrine or methylephedrine, when\nexceeding the urine concentrations listed below.</p>\n</blockquote>\n<p>Using the category <em>phenethylamine stimulants</em> would be scientifically correct and provide a useful contrast to the category of non-prohibited stimulants, i.e. caffeine.</p>\n" } ]

[ "https://health.stackexchange.com/questions/29365", "https://health.stackexchange.com", "https://health.stackexchange.com/users/1248/" ]

[ { "answer_id": 29382, "author": "Polyhat", "author_id": 24340, "author_profile": "https://health.stackexchange.com/users/24340", "pm_score": -1, "selected": false, "text": "<p>Theoretically, if both parents are O+, there is no chance of an A+ child. Type O blood is recessive, and must be homozygous to exhibit as the blood type. However, if one parent was mistyped, and carried O but had type A blood as his/her dominant type, then of course this would be possible.</p>\n<p>Allegedly there are occasional genetic mysteries called &quot;throwbacks&quot; (cf. &quot;<a href=\"https://en.wikipedia.org/wiki/Atavism\" rel=\"nofollow noreferrer\">atavism</a>&quot;) which present unusual anomalies (e.g. two Caucasian parents having a black child). But aside from something of this nature, of whose possibility in this case I am uncertain, some of the possible causes might include:</p>\n<ul>\n<li>One parent actually has type A blood (could have had blood mistyped, or parent was misidentified).</li>\n<li>The child was mistyped, and needs to be retested.</li>\n<li>Blood samples on test day were cross-labeled (mixed up).</li>\n<li>The parents brought home the wrong infant from the hospital.</li>\n<li>Etc.</li>\n</ul>\n<p>Was the blood test done at school and the child, too afraid of the finger prick, begged some friend to &quot;help&quot;? There are a number of possibilities that one might consider, but to have an A+ child from two O+ parents is not one that I would consider.</p>\n<p>Neither does the Red Cross, though they do seem hesitant to make a perfectly definitive declaration on account of potential issues with testing, as seen in their remarks below their blood-type graphic (available <a href=\"https://www.redcrossblood.org/donate-blood/blood-types.html?icid=rdrt-blood-types&amp;imed=direct&amp;isource=redirect\" rel=\"nofollow noreferrer\">HERE</a>).</p>\n<p><a href=\"https://i.stack.imgur.com/2fr6x.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/2fr6x.png\" alt=\"enter image description here\" /></a></p>\n" }, { "answer_id": 29383, "author": "Fizz", "author_id": 10980, "author_profile": "https://health.stackexchange.com/users/10980", "pm_score": 4, "selected": true, "text": "<p>Although such cases are undoubtedly rare, they are not impossible. Here's <a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-3148.2005.00603.x\" rel=\"noreferrer\">a case report from 2005</a>:</p>\n<blockquote>\n<p>Apparent deviation from Mendelian rules of blood group inheritance is rarely observed. Blood group O parents with children expressing weak A subgroups have occasionally been described but not explained. A detailed serological investigation of such a family is described here. [...]</p>\n<p>The propositus' RBCs were very weakly agglutinated with monoclonal anti-A but distinctly with polyclonal anti-A,B, i.e. typical for Ax. Serum anti-A1 (titre 4) and -B were present. Her parents' blood groups were both clearly O, with titres of serum anti-A1, and -A at 16 and 4, respectively. Adsorption/elution studies demonstrated A antigen on the daughter's cells only. The ABO genotypes were: mother, AxO1; father, O1vO2; and propositus, AxO2. The Ax allele was an A1-O1v hybrid allele with a crossing-over breakpoint between positions 235 and 446 in intron 6 (Ax-4). Compared to the A1 glycosyltransferase, this allele predicts a protein with two amino acid substitutions (Phe216Ile and Met277Val) known to yield either weakly expressed or no A antigen on RBCs.</p>\n<p>This study suggests that the nature of the ABO allele in trans can influence A antigen expression, a phenomenon previously described as allelic enhancement (or reinforcement).</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/29381", "https://health.stackexchange.com", "https://health.stackexchange.com/users/24377/" ]

[ { "answer_id": 29392, "author": "Carey Gregory", "author_id": 805, "author_profile": "https://health.stackexchange.com/users/805", "pm_score": 2, "selected": false, "text": "<p>There isn't an English word that means pre-patient. If you call a doctor's office and ask for an appointment, you become known to them as a patient the minute they type your name into the system. It doesn't matter that they haven't seen you, examined you, or run any tests yet; you're still a patient. That's what I would expect your app to do. Anything else would likely be confusing.</p>\n<p>Source: Personal experience writing patient care reports and developing medical software.</p>\n" }, { "answer_id": 29393, "author": "Jiminy Cricket.", "author_id": 15405, "author_profile": "https://health.stackexchange.com/users/15405", "pm_score": 2, "selected": true, "text": "<p><strong>Candidate.</strong></p>\n<p>1 b: one likely or suited to undergo or be chosen for something specified\n(e.g. a candidate for surgery).</p>\n<p>^{<a href=\"https://www.merriam-webster.com/dictionary/candidate\" rel=\"nofollow noreferrer\">Merriam Webster.</a>}</p>\n" } ]

[ "https://health.stackexchange.com/questions/29391", "https://health.stackexchange.com", "https://health.stackexchange.com/users/24382/" ]

[ { "answer_id": 29434, "author": "Bashi", "author_id": 24420, "author_profile": "https://health.stackexchange.com/users/24420", "pm_score": 3, "selected": true, "text": "<p>Carbohydrates are the main source of energy in humans.\nCarbohydrates are almost always recommended as part of a healthy diet even in sedentary people, but what changes is the amount consumed.\nKetogenic diet favor consumption of high amounts of fat and low carbohydrates, some people try to live by this diet although one should be careful about their glucose level as it could lead to hypoglycemia. If i am not mistaken ketogenic diet is used in children for specific types of epilepsy, but these patients are monitored for hypoglycemia and other side effects. I am not well informed about the diet and it's use as treatment for epilepsy (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361831/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361831/</a>)</p>\n<p>Off the top of my head i can recall some Fatty-acid metabolism disorders (in general enzymatic disorders) that require the consumption of carbohydrates to maintain suitable levels of glucose because it will be the only source of energy for the body, and a decrease in glycemia could lead even to coma and death because the body cannot use the fat to produce energy in case glucose is reduced in blood. In fact consuming enough amounts of carbohydrates could be the only treatment for some of these disorders and glass of sugar water could be a life saving even in sedentary people.\n(<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331364/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331364/</a>)</p>\n" }, { "answer_id": 30472, "author": "personal_cloud", "author_id": 24330, "author_profile": "https://health.stackexchange.com/users/24330", "pm_score": 0, "selected": false, "text": "<p>Attempting to <em>eliminate</em> carbs from the diet tends to lead to a restrictive diet that may lack fiber, micronutrients, etc. Diets such as <a href=\"https://cellucor.com/blogs/nutrition/the-pros-and-cons-40-30-30-diet\" rel=\"nofollow noreferrer\">40-30-30</a> that seek to <em>integrate</em> foods in moderation rather than eliminating them tend to be more successful in the long term due to the increased flexibility.</p>\n" } ]

[ "https://health.stackexchange.com/questions/29398", "https://health.stackexchange.com", "https://health.stackexchange.com/users/24330/" ]

[ { "answer_id": 29434, "author": "Bashi", "author_id": 24420, "author_profile": "https://health.stackexchange.com/users/24420", "pm_score": 3, "selected": true, "text": "<p>Carbohydrates are the main source of energy in humans.\nCarbohydrates are almost always recommended as part of a healthy diet even in sedentary people, but what changes is the amount consumed.\nKetogenic diet favor consumption of high amounts of fat and low carbohydrates, some people try to live by this diet although one should be careful about their glucose level as it could lead to hypoglycemia. If i am not mistaken ketogenic diet is used in children for specific types of epilepsy, but these patients are monitored for hypoglycemia and other side effects. I am not well informed about the diet and it's use as treatment for epilepsy (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361831/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361831/</a>)</p>\n<p>Off the top of my head i can recall some Fatty-acid metabolism disorders (in general enzymatic disorders) that require the consumption of carbohydrates to maintain suitable levels of glucose because it will be the only source of energy for the body, and a decrease in glycemia could lead even to coma and death because the body cannot use the fat to produce energy in case glucose is reduced in blood. In fact consuming enough amounts of carbohydrates could be the only treatment for some of these disorders and glass of sugar water could be a life saving even in sedentary people.\n(<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331364/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331364/</a>)</p>\n" }, { "answer_id": 30472, "author": "personal_cloud", "author_id": 24330, "author_profile": "https://health.stackexchange.com/users/24330", "pm_score": 0, "selected": false, "text": "<p>Attempting to <em>eliminate</em> carbs from the diet tends to lead to a restrictive diet that may lack fiber, micronutrients, etc. Diets such as <a href=\"https://cellucor.com/blogs/nutrition/the-pros-and-cons-40-30-30-diet\" rel=\"nofollow noreferrer\">40-30-30</a> that seek to <em>integrate</em> foods in moderation rather than eliminating them tend to be more successful in the long term due to the increased flexibility.</p>\n" } ]

[ "https://health.stackexchange.com/questions/30538", "https://health.stackexchange.com", "https://health.stackexchange.com/users/24514/" ]

[ { "answer_id": 29434, "author": "Bashi", "author_id": 24420, "author_profile": "https://health.stackexchange.com/users/24420", "pm_score": 3, "selected": true, "text": "<p>Carbohydrates are the main source of energy in humans.\nCarbohydrates are almost always recommended as part of a healthy diet even in sedentary people, but what changes is the amount consumed.\nKetogenic diet favor consumption of high amounts of fat and low carbohydrates, some people try to live by this diet although one should be careful about their glucose level as it could lead to hypoglycemia. If i am not mistaken ketogenic diet is used in children for specific types of epilepsy, but these patients are monitored for hypoglycemia and other side effects. I am not well informed about the diet and it's use as treatment for epilepsy (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361831/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361831/</a>)</p>\n<p>Off the top of my head i can recall some Fatty-acid metabolism disorders (in general enzymatic disorders) that require the consumption of carbohydrates to maintain suitable levels of glucose because it will be the only source of energy for the body, and a decrease in glycemia could lead even to coma and death because the body cannot use the fat to produce energy in case glucose is reduced in blood. In fact consuming enough amounts of carbohydrates could be the only treatment for some of these disorders and glass of sugar water could be a life saving even in sedentary people.\n(<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331364/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331364/</a>)</p>\n" }, { "answer_id": 30472, "author": "personal_cloud", "author_id": 24330, "author_profile": "https://health.stackexchange.com/users/24330", "pm_score": 0, "selected": false, "text": "<p>Attempting to <em>eliminate</em> carbs from the diet tends to lead to a restrictive diet that may lack fiber, micronutrients, etc. Diets such as <a href=\"https://cellucor.com/blogs/nutrition/the-pros-and-cons-40-30-30-diet\" rel=\"nofollow noreferrer\">40-30-30</a> that seek to <em>integrate</em> foods in moderation rather than eliminating them tend to be more successful in the long term due to the increased flexibility.</p>\n" } ]

[ "https://health.stackexchange.com/questions/30556", "https://health.stackexchange.com", "https://health.stackexchange.com/users/21148/" ]

[ { "answer_id": 30577, "author": "Brian Ó Maoláin", "author_id": 24505, "author_profile": "https://health.stackexchange.com/users/24505", "pm_score": 3, "selected": false, "text": "<p>Your first source does not appear to support the idea that boosters are now ineffective, only that they are possibly less effective.</p>\n<blockquote>\n<p>We next examined the impact of a Pfizer booster dose, administrated 7 months after Pfizer vaccination. The sera were collected one month after the third dose. The booster dose enhanced\nneutralization titers against D614G and Delta by 39 and 49 fold... It was also associated with strong increase of the neutralization activity against Omicron 100% of the tested sera displayed a neutralizing activity at this time point.</p>\n</blockquote>\n<p>We can only speculate but I would guess the reason why there hasn't been a major change in public health policy is likely that this is still preliminary research and it would be unwise to hastily halt a very large programme that has up to now been quite effective.</p>\n" }, { "answer_id": 30586, "author": "motosubatsu", "author_id": 11188, "author_profile": "https://health.stackexchange.com/users/11188", "pm_score": 2, "selected": false, "text": "<p>The discussion section in the <a href=\"https://media.nature.com/original/magazine-assets/d41586-021-03827-2/d41586-021-03827-2.pdf\" rel=\"nofollow noreferrer\">paper</a> in your first link makes the case for the booster programs:</p>\n<blockquote>\n<p>A booster dose significantly improves the quality and the level of the humoral immune response and is associated with a strong protection against severe forms of disease. An accelerated deployment of vaccines and boosters throughout the world is necessary to counteract viral spread.</p>\n</blockquote>\n<p>This was consistent with the reduced neutralization levels they saw of the booster vs Omicron compared with booster vs Delta, and they cited an Israeli study <a href=\"https://www.thelancet.com/action/showPdf?pii=S0140-6736%2821%2902249-2\" rel=\"nofollow noreferrer\"><em>Barda et al</em></a> to support that this does indeed translate into clinical outcomes.</p>\n<blockquote>\n<p>Could you please clarify this: &quot;Altogether, these results indicate that Omicron is poorly or not neutralized by vaccinees’ sera sampled 5 months after vaccination. The booster dose triggered a detectable cross-neutralization activity against Omicron. However, even after the booster dose the variant displayed a reduction of ED50 of 18 and 6 fold, when compared to D614G and Delta, respectively.&quot;</p>\n</blockquote>\n<p>Pretty much what it says - at ~5 months after the previous vaccination the performance against Omicron was poor, it was already reduced vs Delta at that interval as well, and since the vaccination isn't <em>quite</em> as effective against the Omicron variant as it is against Delta the end result was that at that point in the cycle it was barely doing anything against Omicron.</p>\n<p>When you add the booster dose in it's more effective against Omicron (albeit still not <em>as</em> effective as it is against Delta),</p>\n<p>At two doses + 5 months less than 12% of individuals were producing neutralizing antibodies sufficient for an effect against Omicron but at <em>three</em> doses 100% of the individuals they tested contained neutralizing antibodies:</p>\n<p><a href=\"https://i.stack.imgur.com/xnGWn.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/xnGWn.png\" alt=\"Extended Data Fig.5 ('a' and 'b')\" /></a></p>\n<p>Yes the antigenic differences between Delta and Omicron means the <em>levels</em> of these antibodies capable of neutralizing it is lower vs Omicron than the other variants but it's still sufficient to have a significant benefit in reducing the severity of the disease in those that get it, i.e. fewer people in hospital, fewer &quot;severe&quot; cases, and of course fewer deaths:</p>\n<p><a href=\"https://i.stack.imgur.com/4jHkj.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/4jHkj.png\" alt=\"Barda et al Fig.1\" /></a></p>\n<p>It might sound callous but frankly those who aren't sick enough to need hospital treatment aren't in much danger, and the &quot;treatment&quot; for them is to stay at home for 7-10 days and try not to cough on too many people in the meantime.</p>\n<p>The paper on the use of therapeutic mAbs that a better &quot;targeted&quot; to Omicron than those produced by the immune response of vaccinated/convalescent individuals looks interesting, although as seen in the <em>Schwartz</em> article the performance against Omicron varies considerably among the different mAbs, arguably falling victim to the same differences in the new variant that have affected the vaccine performance. I'm not saying it's not worth pursuing - and certainly in the UK the NHS is using sotrovimab treatments (which seems to work against Omicron) for those in certain <a href=\"https://www.nhs.uk/medicines/sotrovimab/who-can-and-cannot-have-sotrovimab/\" rel=\"nofollow noreferrer\">high-risk categories</a> who have tested positive.</p>\n<p>But there's some scaling issues to consider - sotrovimab is given on an IV over a 30 minute period plus a 30 minute monitoring period. So that's an <em>hour</em> per patient, plus any booking in and admin overhead, at a time when clinical resources are already at premium. A vaccine booster takes seconds to administer (certainly my whole appointment from walking in the door of the building to back out was less than 5 minutes including all the admin!), and can be administered by staff with a comparatively low level of clinical training and also be done pretty much <em>anywhere</em> (pharmacy, shopping center, gazebo in a carpark etc).</p>\n<p>So the vaccines are already here, already tested, already mass-produced and already have a logistical infrastructure in place to give them to people on a massive scale. So, with the waning immunity offered by the previous two doses in the populations of places like Great Britain and France coupled with the highly infectious nature of Omicron a quickly spun-up booster program that provides not perfect but still pretty good protection to the general population seems to be a rather sensible route to take.</p>\n" }, { "answer_id": 30611, "author": "bob1", "author_id": 24128, "author_profile": "https://health.stackexchange.com/users/24128", "pm_score": 4, "selected": true, "text": "<p>As OP doesn't like the data presented in the other answers I will add the data recently published in <a href=\"https://www.nejm.org/doi/full/10.1056/NEJMc2119641?query=RP\" rel=\"nofollow noreferrer\">New England Journal of Medicine</a> article titled &quot;<em>Plasma Neutralization of the SARS-CoV-2 Omicron Variant</em>&quot;¹</p>\n<p>In this article the authors compare vaccine with and without booster to infection with booster. The findings are that vaccination with booster (6 months post initial vaccination course) results in higher neutralization titres by as much as 38x. Infection followed by vaccination results in greater neutralization titres, providing up to 154x higher. It is not discussed how this relates to protection from disease, but generally increased neutralizing titres will relate to greater protection.</p>\n<p>(only) Fig from article:</p>\n<p><a href=\"https://i.stack.imgur.com/jmvQM.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/jmvQM.jpg\" alt=\"NEJM neutralization titres omicron\" /></a></p>\n<p>There is also <a href=\"https://www.nejm.org/doi/full/10.1056/NEJMc2119358\" rel=\"nofollow noreferrer\">this article</a> (also from NEJM) showing the neutralization titres of 2 vs 3 Pfizer vaccines in a very small (20 people/group) study in Israel, which shows that with the regular course of vaccination, there is some neutralization of the Omicron, but not much, but when boosted that value increases².</p>\n<p><a href=\"https://i.stack.imgur.com/EEMWW.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/EEMWW.png\" alt=\"NEJM Omi neutralization\" /></a></p>\n<p>In addition, there is a <a href=\"https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v1.full\" rel=\"nofollow noreferrer\">pre-print from a Danish study</a> that found that the odds-ratio risk of infection is 0.54 for booster vaccinated compared to fully vaccinated³. An odds-ratio of 1.00 would be the same as the reference value, so a lower value is less risk of infection.</p>\n<p><a href=\"https://i.stack.imgur.com/RuMYv.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/RuMYv.png\" alt=\"Archive\" /></a></p>\n<p>Edited to add a paper from <a href=\"https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(21)00267-6/fulltext\" rel=\"nofollow noreferrer\">Lancet Microbe</a> linked by OP in the comments which looked at the efficacy of the several vaccines against some of the variants, not Omicron, but covering Delta. In this paper⁴ they found, as others have done that there is a reduction in the efficacy of the vaccine against variants, and attempted to model what would happen if boosted or not. The figures are fairly complex, but show that protection from vaccination without booster is lower than if boosted for all of the vaccines studied:</p>\n<p>Figure 3 from Lancet:\n<a href=\"https://i.stack.imgur.com/BYNh1.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/BYNh1.png\" alt=\"Lancet 1\" /></a></p>\n<p>Figure 4 from Lancet:\n<a href=\"https://i.stack.imgur.com/cceeN.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/cceeN.png\" alt=\"Lancet 2\" /></a></p>\n<p>In conclusion, with the data presented in other answers, it seems that booster vaccination provides protection against the omicron variant that the regular vaccination course does not, and also provides protection against the other variants too.</p>\n<p>1: Schmidt <em>et al</em>., NEJM. Dec 30 2021.</p>\n<p>2: Nemet <em>et al</em>., NEJM. Dec 29 2021.</p>\n<p>3: Lyngse <em>et al</em>., MedArchive. Dec 17 2021.</p>\n<p>4: Cromer <em>et al</em>., Lancet Microbe 3(1), e52-e61, Jan 01 2022.</p>\n" } ]

[ "https://health.stackexchange.com/questions/30576", "https://health.stackexchange.com", "https://health.stackexchange.com/users/17384/" ]

[ { "answer_id": 30667, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 2, "selected": false, "text": "<p><a href=\"https://emedicine.medscape.com/article/437096-overview\" rel=\"nofollow noreferrer\">Nephrolithiasis</a> specifically refers to calculi (calcium stones) in the kidneys, but</p>\n<blockquote>\n<p>renal calculi and ureteral calculi (ureterolithiasis) are often discussed in conjunction. Ureteral calculi almost always originate in the kidneys, although they may continue to grow once they lodge in the ureter.</p>\n</blockquote>\n<p>When talking about intravenous contrast agents for radiological images of the urinary system, you are very likely talking about an Intravenous pyelogram (IVP) <strong>[Source: <a href=\"https://www.radiologyinfo.org/en/info/ivp\" rel=\"nofollow noreferrer\">Radiologyinfo.org</a>]</strong>.</p>\n<blockquote>\n<p>Intravenous pyelogram (IVP) is an x-ray exam that uses an injection of contrast material to evaluate your kidneys, ureters and bladder and help diagnose blood in the urine or pain in your side or lower back.</p>\n<p><strong>[...]</strong></p>\n<p>When contrast material is injected into a vein in the patient's arm, it travels through the blood stream and collects in the kidneys and urinary tract, turning these areas bright white on the x-ray images. An IVP allows the radiologist to view and assess the anatomy and function of the kidneys, ureters and the bladder.</p>\n<p><strong>[...]</strong></p>\n<p>The IVP exam can enable the radiologist to detect problems within the urinary tract resulting from:</p>\n<ul>\n<li>kidney stones</li>\n<li>enlarged prostate</li>\n<li>tumors in the kidney, ureters or urinary bladder</li>\n<li>scarring from urinary tract infection</li>\n<li>surgery on the urinary tract</li>\n<li>congenital anomalies of the urinary tract</li>\n</ul>\n</blockquote>\n<p>With CT exams, the reason for the the contrast agent is the same as x-rays. Computed tomography (CT) is an imaging tool that combines x-rays with computer technology to produce a more detailed, cross-sectional image of your body. <strong>[Source: <a href=\"https://orthoinfo.aaos.org/en/treatment/x-rays-ct-scans-and-mris/\" rel=\"nofollow noreferrer\">American Academy of Orthopaedic Surgeons</a>]</strong></p>\n<p>CT images may add valuable information about the functioning tissue of the kidneys and surrounding structures nearby the kidneys, ureters and bladder. Small urinary tract tumors and stones are more easily identified on these examinations. <strong>[Source: <a href=\"https://www.radiologyinfo.org/en/info/ivp\" rel=\"nofollow noreferrer\">Same Radiologyinfo.org link above</a>]</strong></p>\n" }, { "answer_id": 30783, "author": "Jrapa86", "author_id": 24004, "author_profile": "https://health.stackexchange.com/users/24004", "pm_score": 1, "selected": false, "text": "<p>To help answer your question, if we are independently suspecting urinary calculi (whether it is within the kidney, ureter, or bladder), the imaging of choice is a CT scan without contrast. The reason for this is because the utilization of contrast can obscure the stone. What I mean is, the presence of contrast on a CT scan appears &quot;white&quot; (aka enhanced). So does a calculi. What if, at the moment the image was taken, the contrast is present behind, or in front of the stone (such as a vascular structure). Or perhaps oral contrast was also administered, and present within the intestine, and the stone is within the ureter, at the level of that portion of the intestine. You wont see the stone, because the contrast sitting in the intestine is now hiding it. Now of course, you have separate views and angles you can look at on the CT, but overall it makes it harder to find the stone. In a CT without contrast, the stone is much easier to find, because it will likely be the brightest shade of white (other than bone), in an area where it otherwise wouldn't belong. Also there are risks with contrast, such as contrast nephropathy. Therefore, why administer contrast, if what you are suspecting is a kidney stone? Contrast is also contraindicated if your kidney function is decreased (measured by your serum creatinine.)</p>\n<p>Now let's say we are interested in the kidney's perfusion (amount of blood getting to it.) Or perhaps, if the kidney is infected (pyelonephritis.) In this scenario, IV contrast is beneficial. IV contrast will enhance the infected kidney, help discern if there is even potentially an abscess, and additionally you can see if there is any arterial narrowing within the supply to the kidney (such as renal artery stenosis). IV contrast is drawn to areas of high metabolic activity, and it comes from the intravascular space (because it is injected intravenously.) Pathologic diagnosis comes from either</p>\n<ul>\n<li>Contrast is present where it doesn't belong</li>\n<li>Contrast is much higher in a region that is within a structure</li>\n<li>Contrast is 'smeared' near where it is expected to be within a vascular structure.</li>\n<li>Contrast is higher in a focal region within a structure, with a central region of abrupt absence.</li>\n</ul>\n<p>These examples are what providers usually look for when ordering an image with contrast. Contrast where it doesnt belong can mean many things, some examples are a vascular leak, or severe infection. Contrast much higher in a specific region within a structure usually indicates infectious. Contrast smeared near a vascular structure has a term called 'extrav' which means the vascular structure is perforated and leaking. Contrast with a higher focus of contrast within a structure, with a central region of abrupt absence may indicate an abscess (a walled off portion of the infection filled with pus, and doesn't have a vascular supply therefore no contrast gets to it.)</p>\n<p>If you are worried about the function of motility within the urinary tract, this is when a pyelogram may be beneficial. For example, a ureteral stricture, or perhaps a ureteral leak.</p>\n" } ]

[ "https://health.stackexchange.com/questions/30647", "https://health.stackexchange.com", "https://health.stackexchange.com/users/5371/" ]

[ { "answer_id": 30669, "author": "Ian Campbell", "author_id": 22190, "author_profile": "https://health.stackexchange.com/users/22190", "pm_score": 3, "selected": true, "text": "<h4>Of the three vaccine products that have been approved or had emergency use authorization in the United States, all used saline placebo in the clinical trial.</h4>\n<p>From the Pfizer <a href=\"https://doi.org/10.1056/NEJMoa2034577\" rel=\"nofollow noreferrer\">Polack et al paper</a>:</p>\n<blockquote>\n<p>With the use of an interactive Web-based system, participants in the trial were randomly assigned in a 1:1 ratio to receive 30 μg of BNT162b2 (0.3 ml volume per dose) or <strong>saline placebo</strong>.</p>\n</blockquote>\n<p>From the Moderna <a href=\"https://doi.org/10.1056/nejmoa2035389\" rel=\"nofollow noreferrer\">Baden et al paper</a>:</p>\n<blockquote>\n<p>Injections were given 28 days apart, in the same arm, in a volume of 0.5 ml containing 100 μg of mRNA-1273 or <strong>saline placebo</strong>.</p>\n</blockquote>\n<p>From the Johnson &amp; Johnson <a href=\"https://doi.org/10.1056/NEJMoa2101544\" rel=\"nofollow noreferrer\">Sadoff et al paper</a>:</p>\n<blockquote>\n<p>Participants were randomly assigned in a 1:1 ratio, with the use of randomly permuted blocks, to receive either Ad26.COV2.S or <strong>saline placebo</strong>.</p>\n</blockquote>\n<p>Thus, we should expect that a mild salt water solution would not elicit much of an immune response. This is a potential weakness of the trial design. Nonetheless, the results were sufficient to result in full approval of the Pfizer product.</p>\n" }, { "answer_id": 30681, "author": "De Novo", "author_id": 14173, "author_profile": "https://health.stackexchange.com/users/14173", "pm_score": 3, "selected": false, "text": "<p>The AstraZeneca COVID-19 vaccine approved by <a href=\"https://www.ema.europa.eu/en/medicines/human/EPAR/vaxzevria-previously-covid-19-vaccine-astrazeneca\" rel=\"noreferrer\">EU</a> and <a href=\"https://www.gov.uk/government/publications/regulatory-approval-of-covid-19-vaccine-astrazeneca\" rel=\"noreferrer\">UK</a> regulatory authorities used a meningitis vaccine as the control in phase 2/3 trials.</p>\n<p>From the methods section of <a href=\"https://doi.org/10.1016/S0140-6736(20)32466-1\" rel=\"noreferrer\">their paper</a>:</p>\n<blockquote>\n<p>Participants were randomly assigned to receive either the ChAdOx1 nCoV-19 vaccine or the quadrivalent MenACWY protein-polysaccharide conjugate vaccine. MenACWY was used as a comparator vaccine rather than a saline placebo to maintain masking of participants who had local or systemic reactions.</p>\n</blockquote>\n<p>Confidence intervals for side effects overlapped between the treatment and control groups (see the appendix in the above linked paper), though the study wasn't powered to detect moderate differences. It seems these investigators may have met their goal of avoiding unmasking due to side effects.</p>\n<p>This doesn't guarantee that unmasking didn't occur for some other reason. I'd note that no masking assessment was reported, though it rarely is. It is possible to assess masking by, e.g., asking participants whether they think they received the treatment or control. Unmasking can occur for a variety of reasons, side effects are just one of them. For example, trials of interventions that are a bit more complex than a pill (e.g., injection, IV) often don't blind staff who administer the intervention and control, but keep the participants, investigators, and the people who collect the data blind. This comes with a risk of unmasking, but is balanced against the challenge (and likely failure) of making the intervention and treatment look exactly alike, push exactly alike, etc.</p>\n" } ]

[ "https://health.stackexchange.com/questions/30651", "https://health.stackexchange.com", "https://health.stackexchange.com/users/24590/" ]

[ { "answer_id": 30669, "author": "Ian Campbell", "author_id": 22190, "author_profile": "https://health.stackexchange.com/users/22190", "pm_score": 3, "selected": true, "text": "<h4>Of the three vaccine products that have been approved or had emergency use authorization in the United States, all used saline placebo in the clinical trial.</h4>\n<p>From the Pfizer <a href=\"https://doi.org/10.1056/NEJMoa2034577\" rel=\"nofollow noreferrer\">Polack et al paper</a>:</p>\n<blockquote>\n<p>With the use of an interactive Web-based system, participants in the trial were randomly assigned in a 1:1 ratio to receive 30 μg of BNT162b2 (0.3 ml volume per dose) or <strong>saline placebo</strong>.</p>\n</blockquote>\n<p>From the Moderna <a href=\"https://doi.org/10.1056/nejmoa2035389\" rel=\"nofollow noreferrer\">Baden et al paper</a>:</p>\n<blockquote>\n<p>Injections were given 28 days apart, in the same arm, in a volume of 0.5 ml containing 100 μg of mRNA-1273 or <strong>saline placebo</strong>.</p>\n</blockquote>\n<p>From the Johnson &amp; Johnson <a href=\"https://doi.org/10.1056/NEJMoa2101544\" rel=\"nofollow noreferrer\">Sadoff et al paper</a>:</p>\n<blockquote>\n<p>Participants were randomly assigned in a 1:1 ratio, with the use of randomly permuted blocks, to receive either Ad26.COV2.S or <strong>saline placebo</strong>.</p>\n</blockquote>\n<p>Thus, we should expect that a mild salt water solution would not elicit much of an immune response. This is a potential weakness of the trial design. Nonetheless, the results were sufficient to result in full approval of the Pfizer product.</p>\n" }, { "answer_id": 30681, "author": "De Novo", "author_id": 14173, "author_profile": "https://health.stackexchange.com/users/14173", "pm_score": 3, "selected": false, "text": "<p>The AstraZeneca COVID-19 vaccine approved by <a href=\"https://www.ema.europa.eu/en/medicines/human/EPAR/vaxzevria-previously-covid-19-vaccine-astrazeneca\" rel=\"noreferrer\">EU</a> and <a href=\"https://www.gov.uk/government/publications/regulatory-approval-of-covid-19-vaccine-astrazeneca\" rel=\"noreferrer\">UK</a> regulatory authorities used a meningitis vaccine as the control in phase 2/3 trials.</p>\n<p>From the methods section of <a href=\"https://doi.org/10.1016/S0140-6736(20)32466-1\" rel=\"noreferrer\">their paper</a>:</p>\n<blockquote>\n<p>Participants were randomly assigned to receive either the ChAdOx1 nCoV-19 vaccine or the quadrivalent MenACWY protein-polysaccharide conjugate vaccine. MenACWY was used as a comparator vaccine rather than a saline placebo to maintain masking of participants who had local or systemic reactions.</p>\n</blockquote>\n<p>Confidence intervals for side effects overlapped between the treatment and control groups (see the appendix in the above linked paper), though the study wasn't powered to detect moderate differences. It seems these investigators may have met their goal of avoiding unmasking due to side effects.</p>\n<p>This doesn't guarantee that unmasking didn't occur for some other reason. I'd note that no masking assessment was reported, though it rarely is. It is possible to assess masking by, e.g., asking participants whether they think they received the treatment or control. Unmasking can occur for a variety of reasons, side effects are just one of them. For example, trials of interventions that are a bit more complex than a pill (e.g., injection, IV) often don't blind staff who administer the intervention and control, but keep the participants, investigators, and the people who collect the data blind. This comes with a risk of unmasking, but is balanced against the challenge (and likely failure) of making the intervention and treatment look exactly alike, push exactly alike, etc.</p>\n" } ]

[ "https://health.stackexchange.com/questions/30665", "https://health.stackexchange.com", "https://health.stackexchange.com/users/5371/" ]

[ { "answer_id": 30776, "author": "Bryan Krause", "author_id": 8728, "author_profile": "https://health.stackexchange.com/users/8728", "pm_score": 3, "selected": true, "text": "<p>I don't know if there are canonical references for these measurements. I've found a couple references that seem good enough for an order-of-magnitude estimate, though.</p>\n<p><em>Latour, A. W., Peterson, D. D., &amp; Riner, D. D. (2019). Comparing Alternate Percent Body Fat Estimation Techniques for United States Navy Body Composition Assessment. International Journal of Kinesiology in Higher Education, 3(4), 93-105.</em></p>\n<p>Latour et al compare gold standard estimates with <a href=\"https://en.wikipedia.org/wiki/Dual-energy_X-ray_absorptiometry\" rel=\"nofollow noreferrer\">Dual Energy X-ray Absorptiometry (DEXA)</a> with US Navy-style estimates based on circumference. There are some differences according to how exactly circumference is used in the US Navy method, and differences for men versus women, but overall standard error of estimate ranged from 3.42-4.21%, in absolute percentage points, with Pearson correlations between methods ranging from .732 to .819. However, there was also an offset in their sample; the mean DEXA for men was 19.3 versus 16.1 using the Navy method, and DEXA for women was 26.9 versus 27.5 using the Navy method. This could reflect systematic differences in the population that the Navy estimates were based off of versus the study population in this study's sample.</p>\n<p><em>He, M., Tan, K. C. B., Li, E. T. S., &amp; Kung, A. W. C. (2001). Body fat determination by dual energy X-ray absorptiometry and its relation to body mass index and waist circumference in Hong Kong Chinese. International journal of obesity, 25(5), 748-752.</em></p>\n<p>This study compared BMI and DEXA estimates and found a standard error of estimate of 4.6% in a regression with BMI only, and 4.3% including age; they also found a standard error of estimate of 4.4% using waist circumference (again, as far as I can tell these are all absolute measurements and assume normality of residuals). This is using an in-sample estimate of the correlation again, though, so you might expect errors to be greater in another population.</p>\n<p>I think you'll find that these errors are large compared to the range of interesting variation in body fat. It seems that these estimates tell you very little compared to what would otherwise be apparent from visual inspection. BMI rather notoriously fails when applied to athletes and bodybuilders, for example, who can clearly be observed to have low body fat, whatever a BMI measurement would suggest.</p>\n<p>In closing I wanted to again emphasize that these are <em>absolute percentages</em>, so if you estimate body fat % to be, say, 20%, and error is 4%, you would say that within 1 standard deviation you're looking at a range of 16-24%.</p>\n" }, { "answer_id": 30791, "author": "Azor Ahai -him-", "author_id": 12367, "author_profile": "https://health.stackexchange.com/users/12367", "pm_score": 3, "selected": false, "text": "<p>Frankenfield and colleagues [1] reported an immense variation between BMI and BFP below a BMI of 30 (obese, or 25% BFP in men and 30% in women according to the same study).</p>\n<blockquote>\n<p>The r^2 value for predicted versus measured body fat/height^2 was 0.567 in men with a BMI below 30 kg/m^2 and 0.996 in men with a BMI above 30 kg/m^2 (corresponding values for women were 0.933 and 0.998, respectively).</p>\n</blockquote>\n<p><a href=\"https://i.stack.imgur.com/L4dj3.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/L4dj3.png\" alt=\"enter image description here\" /></a></p>\n<p><em>Solid circles: men; open: women</em></p>\n<p>From this graph we can also estimate that the SD of the measurement error is <strong>3-4.5 absolute percent</strong>, which aligns neatly with Bryan Krause's <a href=\"https://medicalsciences.stackexchange.com/a/30776/12367\">answer</a>, which is large relative to the range of BFP values of under 25/30%.</p>\n<hr />\n<p>Bowden and colleagues [2] used <a href=\"https://en.wikipedia.org/wiki/Dual-energy_X-ray_absorptiometry\" rel=\"nofollow noreferrer\">DEXA</a> as the gold standard in a sedentary sample. They similarly found a correlation of r=.551 for BMI and DEXA. They provided enough stats in their paper I was estimated the SD of difference between the BMI method and the DEXA measurement as <strong><em>7.5%</em> in men and <em>8.1%</em> in women</strong> which is nearly half the BFP measurements of the skinniest participants, although my analysis was constrained by lack of information, and the true value is probably smaller.</p>\n<p>They also calculated a linear model regressing DEXA on skin fold (SF) and biolectrical impedance analysis (BIA), finding similar values (although the SE of the regression isn't the same as the SD of the difference):</p>\n<blockquote>\n<p>A step-wise multiple regression analysis was calculated revealing SF as the greatest predictor of DEXA with 67.5% of variability explained (r2=0.675) followed by BIA (12.1%) and BMI (2.6%). Total variability explained was 82.2% (R2=0.822). Beta weights were calculated for BIA (0.457), SF (0.425) and BMI (0.197).</p>\n</blockquote>\n<hr />\n<ol>\n<li><p>Frankenfield, D. C., Rowe, W. A., Cooney, R. N., Smith, J. S., &amp; Becker, D. (2001). Limits of body mass index to detect obesity and predict body composition. Nutrition, 17(1), 26–30. <a href=\"https://doi.org/10.1016/S0899-9007(00)00471-8\" rel=\"nofollow noreferrer\">https://doi.org/10.1016/S0899-9007(00)00471-8</a></p>\n</li>\n<li><p>Bowden, R. G., Lanning, B. A., Doyle, E. I., Johnston, H. M., Nassar, E. I., Slonaker, B., ... &amp; Rasmussen, C. (2005). COMPARISON OF BODY COMPOSITION MEASURES TO DUAL-ENERGY X-RAY ABSORPTIOMETRY. Journal of exercise physiology online, 8(2).</p>\n</li>\n</ol>\n" } ]

[ "https://health.stackexchange.com/questions/30772", "https://health.stackexchange.com", "https://health.stackexchange.com/users/12367/" ]

[ { "answer_id": 30805, "author": "jpa", "author_id": 15702, "author_profile": "https://health.stackexchange.com/users/15702", "pm_score": 2, "selected": false, "text": "<p>Here is a potential option that should at least be better than nothing and not particularly risky.</p>\n<p><strong>Required supplies:</strong></p>\n<ul>\n<li>Iodized salt</li>\n<li>High concentration ethanol (&gt;90%)</li>\n<li>Filter</li>\n</ul>\n<p><strong>Principle:</strong></p>\n<p>Iodized salt contains <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/Potassium-iodide#section=Solubility\" rel=\"nofollow noreferrer\">potassium iodine</a> which has a solubility of 2g / 100g in ethanol. <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/Sodium-chloride#section=Solubility\" rel=\"nofollow noreferrer\">Sodium chloride</a> is less soluble at 0.07 g / 100 g.</p>\n<p><strong>Method:</strong></p>\n<ol>\n<li>Mix salt and ethanol. Use the minimum amount of ethanol required to wet the salt - the salt won't fully dissolve.</li>\n<li>Filter the result and collect the liquid.</li>\n<li>(Optional) Heat to evaporate the alcohol.</li>\n<li>Dilute with water and consume.</li>\n</ol>\n<p><strong>Acquired dose and safety:</strong></p>\n<p>For 1 kg of salt, the amount of potassium iodine separated by this method is probably less than 10 mg. This is far less than the recommended 130 mg dose for radiation emergencies, but more than the 0.2 mg normal daily intake from food. As the goal is to make more normal Iodine-127 than radioactive Iodine-131 available to the body, this will be partially effective.</p>\n<p>All the source materials are safe for human consumption, so the downsides are the same as for drinking a salty cocktail.</p>\n" }, { "answer_id": 30839, "author": "jpa", "author_id": 15702, "author_profile": "https://health.stackexchange.com/users/15702", "pm_score": 2, "selected": false, "text": "<p>Based on <a href=\"https://www.who.int/water_sanitation_health/publications/iodine-02032018.pdf?ua=1\" rel=\"nofollow noreferrer\">WHO report: Iodine as drinking-water disinfectant</a> page 19, common 10% (often labeled 100 mg/mL) povidone-iodine solution can be used as drinking water disinfectant. The recommended amount for killing pathogens is 0.35 - 0.70 mL / liter and results in 4-8 mg / liter of residual iodine after 30 minutes.</p>\n<p>The same report also considers the safety of iodine in drinking water, with iodine concentrations up to 10 mg / liter and timespans of up to several years. Long term incidence of thyroid abnormalities was increased for higher dosages. Acute effects occurred at dosages of more than 1000 mg per day.</p>\n<p>If povidione-iodine disinfectant is available, adding 10 milliliters (2 teaspoons) to 1 liter of water and waiting 30 minutes provides the 130 mg dose that is recommended for adults after a radiation emergency. And if the drinking water source is not clean, this has the extra benefit of killing most bacteria and viruses.</p>\n" } ]

[ "https://health.stackexchange.com/questions/30801", "https://health.stackexchange.com", "https://health.stackexchange.com/users/15702/" ]

[ { "answer_id": 30843, "author": "bob1", "author_id": 24128, "author_profile": "https://health.stackexchange.com/users/24128", "pm_score": 2, "selected": false, "text": "<p>The answer is yes. I found a couple of studies looking at hydroperiodide function in the thyroid. Both of them were from the same group of authors and from the military, where use of these sorts of things is relatively common.</p>\n<p><a href=\"https://pubmed.ncbi.nlm.nih.gov/8108021/\" rel=\"nofollow noreferrer\">One of these studies</a> ¹ (very small, only 14 people, so take with a grain of salt*) looked at how safe it was for people to consume these over a short period, such as when hiking. They found that there was a mild impairment of thyroid function from the uptake of iodine from these tablets:</p>\n<blockquote>\n<p>One week of daily exposure to the iodine load from four tetraglycine hydroperiodide water-purification tablets causes mild impairment of thyroid function in humans.</p>\n</blockquote>\n<p>The second looked at <a href=\"https://pubmed.ncbi.nlm.nih.gov/7829615/\" rel=\"nofollow noreferrer\">adaption of the thyroid to hydroperiodide uptake from these tablets</a>.². Most relevant to your question, they found:</p>\n<blockquote>\n<p>Radioactive iodine uptake was less than 2% after 7 days and remained below 2% in all subjects at 90 days.</p>\n</blockquote>\n<ol>\n<li><p>Georgitis WJ, McDermott MT, Kidd GS. An iodine load from water-purification tablets alters thyroid function in humans. Mil Med. 1993 Dec;158(12):794-7. PMID: 8108021.</p>\n</li>\n<li><p>LeMar HJ, Georgitis WJ, McDermott MT. Thyroid adaptation to chronic tetraglycine hydroperiodide water purification tablet use. J Clin Endocrinol Metab. 1995 Jan;80(1):220-3. doi: 10.1210/jcem.80.1.7829615. PMID: 7829615.</p>\n</li>\n</ol>\n<ul>\n<li>pun intended, it just fits nicely with the topic.</li>\n</ul>\n" }, { "answer_id": 30861, "author": "cbeleites unhappy with SX", "author_id": 11479, "author_profile": "https://health.stackexchange.com/users/11479", "pm_score": 3, "selected": true, "text": "<p>A few thoughts about the dosage:</p>\n<p>130 mg KI contain ≈ 780 nmol I (100 mg). One of the linked tablets contains ≈ 94 nmol I (11.9 mg).<br />\nSo, 8 and 1/3 of the water purification tablets have the same amount of iodine as the 130 mg KI tablet. <a href=\"https://en.wikipedia.org/wiki/Portable_water_purification#Iodine\" rel=\"nofollow noreferrer\">Do not use flavor enhancing stuff that may be sold together with the water purification tablets, though.</a>.</p>\n<p>RDI for adults (without nuclear emergency) is in the order of magnitude of 150 μg.</p>\n<p><a href=\"https://en.wikipedia.org/wiki/Iodised_salt\" rel=\"nofollow noreferrer\">Iodized table salt</a> typically contains in the order of magnitude of very roughly 20 mg I/kg. <em>You'd need to eat 5 kg of iodized table salt to get 100 mg I.</em></p>\n<p>Oxidation state of the iodine bascially does not matter for uptake. The iodine supplementations or treatments range all the way from iodide (-I) over iodine(0) (I_2 ⋅ KI solution, also tetraglycine hydroperiodide is a compound of 16 glycine, 5 I_2 and 4 HI)\n) to iodate (+V). The <a href=\"https://www.who.int/ionizing_radiation/pub_meet/Iodine_Prophylaxis_guide.pdf\" rel=\"nofollow noreferrer\">WHO Iodine prophylaxis guide</a> lists both KI (iodide) and KIO_3 (iodate) dosage for nuclear emergency:</p>\n<p><a href=\"https://i.stack.imgur.com/wkEU8.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/wkEU8.png\" alt=\"WHO recommendation table\" /></a></p>\n<hr />\n<p><strong>Please also read the counterindications, e.g. for adults &gt; 40 yo, iodine prophylaxis is not as generally recommended</strong> due to both higher risk of side effects and lower risk of thyroid cancer (see e.g. the CDC page in the question or the WHO recommendation linked above).</p>\n<p>The WHO guideline spells out very clearly that the subpopulation that most importantly needs iodine prophylaxis in a nuclear emergency (newborns) are also most/more difficult to properly dose.</p>\n<hr />\n<p>Also keep in mind that uptake of iodine (radioactive or not) is low if you are not iodine deficient in the first place. <a href=\"https://en.wikipedia.org/wiki/Iodine_deficiency#Pathophysiology\" rel=\"nofollow noreferrer\">The [adult] human body contains about 15 - 20 mg I in total</a>, so 100 days' RDI or 1 - 2 weeks of Japanese daily input. Or purification tablets for 1.5 l water.</p>\n" } ]

[ "https://health.stackexchange.com/questions/30842", "https://health.stackexchange.com", "https://health.stackexchange.com/users/19986/" ]

[ { "answer_id": 30865, "author": "bob1", "author_id": 24128, "author_profile": "https://health.stackexchange.com/users/24128", "pm_score": 5, "selected": true, "text": "<p>It turns out the answer to this is fairly simple, and but not terribly easy to find.</p>\n<p>In the 1800s a Belgian named <a href=\"https://en.wikipedia.org/wiki/Adolphe_Quetelet\" rel=\"nofollow noreferrer\">Adolphe Quetelet</a> (1796–1874) performed some statistics on the weights and heights of people in Europe and Britain (chiefly France and Britain) and published his seminal work, <em>Sur l'homme et le développement de ses facultés, ou Essai de physique sociale</em> (Treatise on Man and the Development of his Faculties, or Essays on Social Physics) in 1835. The relevant section for this can be <a href=\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/j.1550-8528.1994.tb00047.x\" rel=\"nofollow noreferrer\">found as a PDF</a> for free (I believe) at the Wiley Publishing journal <a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1002/j.1550-8528.1994.tb00047.x\" rel=\"nofollow noreferrer\"><em>Obesity Research</em></a></p>\n<p>In this work, he examined the growth rates and dimensions of people throughout their lifetime, coming to the conclusion that after 30 people reached their maximum height and and after 40 for men and 50 for women, they reached their maximum weights.</p>\n<p>He has this to say about the developmental relationship between weight and height. Emphasis mine in all cases:</p>\n<blockquote>\n<p><strong>If man increased equally in all his dimensions, his weight at different ages would be as the cube of his height.</strong> Now, this is not what we really observe. The increase of weight is slower, except during the fist year after birth; then the proportion which we have just pointed out is pretty regularly observed. But after this period, and until near the age of puberty, the <strong>weight increases nearly as the square of the height</strong>. The development of the weight again becomes very rapid at the time of puberty, and almost stops at the twenty-fifth year. In general, we do not err much when we assume that, during development, the squares of the weight at different ages are as the fifth powers of the height; which naturally leads to this conclusion, in supposing the specific gravity constant, that the transverse growth of man is less than the vertical.</p>\n</blockquote>\n<p>He then goes on to state:</p>\n<blockquote>\n<p>However, if we compare two individuals who are fully developed and well-formed with each other, to ascertain the relations existing between the weight and stature, we shall find that the <strong>weight of developed per- sons, of different heights, is nearly as the square of the stature</strong>. Whence it naturally follows, that a transverse section, giving both the breadth and thickness, is just proportioned to the height of the individual.</p>\n</blockquote>\n<p>and continues after a table of statures and weights:</p>\n<blockquote>\n<p>Thus, the stature of men and women, fully developed and well-formed, varied in the proportion of five to six nearly: it is almost the same with the ratios of the weight to the stature of the two sexes: whence it naturally follows, <strong>as we have already said above, that the weight is in proportion to the square of the stature</strong>.</p>\n</blockquote>\n<p>and finally reaches a list of conclusions, with the 7th being:</p>\n<blockquote>\n<ol start=\"7\">\n<li>After the full development of individuals of both sexes, the weight is almost as the square of the stature. From the two preceding relations, we infer, that increase in height is greater than the transverse increase, including breadth and thickness.</li>\n</ol>\n</blockquote>\n<p>This work was then converted into the <a href=\"https://www.sciencedirect.com/science/article/pii/0021968172900276\" rel=\"nofollow noreferrer\">BMI measurement in 1974 by Ancel Keys in the Journal of Chronic Diseases</a>. In this article they state:</p>\n<blockquote>\n<p>In spite of the fact that it is easy to show that the body form does not remain constant with increasing length, the ponderal index, or the similar Rohrer index,W/H³, has been rather widely used....</p>\n</blockquote>\n<blockquote>\n<p>...In the present paper it will be shown, in confirmation of some recent conclusions of others, that in this respect the ratio W/H² is clearly better than the ponderal index. It is proposed that this ratio, W/H², be termed the body mass index.</p>\n</blockquote>\n" }, { "answer_id": 30866, "author": "Bryan Krause", "author_id": 8728, "author_profile": "https://health.stackexchange.com/users/8728", "pm_score": 4, "selected": false, "text": "<p>BMI isn't a &quot;real&quot; thing, it's an arbitrary measure meant to capture some aspect of &quot;overweightness&quot;. The exponent has traditionally been chosen as &quot;2&quot; because that roughly fit with data observed. In the <a href=\"https://www.sciencedirect.com/science/article/abs/pii/0021968172900276\" rel=\"noreferrer\">Keys et al 1972</a> paper that established BMI, they did try other exponents 1 and 3, but found 2 to be the best correlate of body fat.</p>\n<p>Cubed relationships between length and weight are only an approximation, and species vary quite a bit on how close they are to the &quot;cube rule&quot;. For a real-world application, I've come across this in the context of sport fishing, where it is easy to measure a fish's length but sometimes more difficult (you need a scale; the fish needs to hold still) and possibly harmful to the fish to weigh them; you can estimate an approximate weight from a species-specific formula, however. <a href=\"https://en.wikipedia.org/wiki/Standard_weight_in_fish\" rel=\"noreferrer\">Wikipedia</a> has a page on this with some examples for different species.</p>\n<p>For humans, we simply don't tend to follow a cubed relationship. A XX% change in height for humans is not associated with an equivalent XX% change in width or &quot;depth&quot;, it's associated with something a bit less.</p>\n<p>There have been some suggestions to use a different exponent than 2, though, because with the current formula, BMI tends to not track well with adiposity or health outcomes for the tallest or shortest individuals. A barrier to making this change is <a href=\"https://xkcd.com/927/\" rel=\"noreferrer\">agreeing on which one to use</a> and the inertia of a publication record on the old measure. Here are a few examples, though, where people have investigated whether a different exponent for height and/or weight would better index a healthy/unhealthy body composition (I'm sure there are many more; not all ultimately recommend against the current scaling):</p>\n<p>Foster, D., Karloff, H., &amp; Shirley, K. E. (2016). How well does the standard body mass index or variations with a different exponent predict human lifespan?. Obesity, 24(2), 469-475.</p>\n<p>Garn, S. M., Leonard, W. R., &amp; Hawthorne, V. M. (1986). Three limitations of the body mass index. The American journal of clinical nutrition, 44(6), 996-997.</p>\n<p>Tjeertes, E., Hoeks, S., van Vugt, J. L. A., Stolker, R. J., &amp; Hoofwijk, A. (2017). The new body mass index formula; not validated as a predictor of outcome in a large cohort study of patients undergoing general surgery. Clinical nutrition ESPEN, 22, 24-27.</p>\n<p>Xu, Y., Yan, W., &amp; Cheung, Y. B. (2015). Body shape indices and cardiometabolic risk in adolescents. Annals of Human Biology, 42(1), 70-75.</p>\n" }, { "answer_id": 30871, "author": "nikfilippas", "author_id": 24908, "author_profile": "https://health.stackexchange.com/users/24908", "pm_score": 2, "selected": false, "text": "<p>While the answers of Bob and Bryan are perfectly valid, let me attempt to provide some intuition from a physics/statistics standpoint.</p>\n<p>Generally, when a quantity is proportional to some other quantity, raised to the n-th power, this <code>n</code> power is related to the effective number of degrees of freedom of the independent variable.</p>\n<p>For example, in the inverse <em>square</em> law, the number <em>2</em> arises from the fact that energy disperses in all space uniformly, and there is no degeneracy between any dimensions. The result is that consecutive wavefronts form spherical shells, and the surface area (of the sphere) is proportional to <code>r^2</code>.</p>\n<p>Conversely, humans can't expand in all 3 dimensions equally. The effective number of degrees of freedom for a human is about 2. One comes from the height, which is almost free to change. The other one comes from the combination of 'width' and 'depth'. These two are strongly degenerate - the technical term is that they <em>co-vary</em> almost completely, thus lowering the effective number of degrees of freedom.</p>\n<p>Note, the fact that width and depth are almost degenerate means that there is a linear relation between them. So that third dimension doesn't really play a role, because the human body is not free to grow in all space.</p>\n<p>How do we know that? That's empirical - it's just that the effective number of degrees of freedom for a human is closer to 2 than it is to 3. 3 is simply the upper bound when the object grows uniformly in all directions.</p>\n" } ]

[ "https://health.stackexchange.com/questions/30864", "https://health.stackexchange.com", "https://health.stackexchange.com/users/11469/" ]

[ { "answer_id": 30981, "author": "Bryan Krause", "author_id": 8728, "author_profile": "https://health.stackexchange.com/users/8728", "pm_score": 3, "selected": true, "text": "<h2>These terms do not appear to be used consistently in the literature</h2>\n<p>In this classification, it seems they are possibly using <a href=\"https://en.wikipedia.org/wiki/Prohormone\" rel=\"nofollow noreferrer\">prohormones</a> specifically to indicate <strong>protein/peptide</strong> precursors to peptide hormones (similar to the term &quot;<a href=\"https://en.wikipedia.org/wiki/Zymogen\" rel=\"nofollow noreferrer\">proenzyme</a>&quot;), and <a href=\"https://en.wikipedia.org/wiki/Prehormone\" rel=\"nofollow noreferrer\">prehormone</a> for non-peptide hormone precursors. In this terminology, prohormones will always be a longer peptide chain than the hormone, and the hormone is formed by proteolysis. In that case, preprohormones are just peptides that are cut to make a prohormone, so they are longer chains than the prohormones.</p>\n<p>It's also possible they are intending to separate based on <em>where the conversion takes place</em>, and a prohormone is modified to the final form in the source tissue, whereas a prehormone is released and then modified in target tissue. An example from an old paper, <a href=\"https://muse.jhu.edu/article/406237/pdf\" rel=\"nofollow noreferrer\">Baird et al 1963</a>:</p>\n<blockquote>\n<p>Emmens [1] has defined a prohormone as a substance which exerts its\nbiological effect by peripheral conversion to a more active compound.</p>\n<p>...</p>\n<p>Prehormones may be defined as substances normally present in the\nbody and usually secreted by endocrine glands, which have little or no biological potency themselves but are converted peripherally to more\nactive compounds</p>\n</blockquote>\n<p>I don't think these delineations are particularly consistent from author to author... <a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=prohormone+t4\" rel=\"nofollow noreferrer\">T4 is called a prohormone</a>, too, sometimes, and at least in Google Scholar appears with that word much more often than <a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=prehormone+t4&amp;btnG=\" rel=\"nofollow noreferrer\">&quot;prehormone&quot;</a>.</p>\n<p>Some urge that the delineation is on whether the modification occurs locally or elsewhere; for example <a href=\"https://www.sciencedirect.com/science/article/pii/S0960076004000858\" rel=\"nofollow noreferrer\">this paper</a> argues T4 should not be considered a prohormone because a prohormone is something produced and converted to the final hormone form locally, in the same gland, whereas prehormones are modified to their final form in target tissues.</p>\n<p>Yet another case, <a href=\"https://www.sciencedirect.com/science/article/pii/S2405844019363121\" rel=\"nofollow noreferrer\">this paper</a> refers to a peptide hormone where they call the longest chain &quot;prehormone&quot; which is then shortened to a &quot;prohormone&quot; which is finally shortened to the final product.</p>\n<p>For your course, I'd focus on whatever distinction your textbook/instructor wants to make, but for the rest of life (and this is general advice for all terms in biology) I'd advise:</p>\n<ol>\n<li><p>Make sure you know the basis of what you're being taught, not just the term. Most terminology in biology is just <em>labels</em>, you cannot reason backwards from the term to learn about the world, the term is just a shorthand to cluster some concepts together to organize communication and knowledge.</p>\n</li>\n<li><p>Recognize that terminology is not consistent and you always need to clarify what is specifically meant. Authors of papers and textbooks are not necessarily consistent, as they may have different focuses and values. See also <a href=\"https://en.wikipedia.org/wiki/Lumpers_and_splitters\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Lumpers_and_splitters</a> for one cause of this, and <a href=\"https://xkcd.com/927/\" rel=\"nofollow noreferrer\">https://xkcd.com/927/</a> for one result when people try to &quot;fix&quot; things to be more standard.</p>\n</li>\n</ol>\n" }, { "answer_id": 30982, "author": "Ian Campbell", "author_id": 22190, "author_profile": "https://health.stackexchange.com/users/22190", "pm_score": 2, "selected": false, "text": "<p>I agree with Bryan Krause that the terms are used inconsistently in the literature. However, at least to a subset of authors (and to me), the biologic difference is clear.</p>\n<h4>Preprohormones</h4>\n<p>Preprohormones are peptide hormones that have just been translated from their mRNA.</p>\n<p>Rehfeld provides an excellent review of many types of peptide hormones (2004. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/9587068/\" rel=\"nofollow noreferrer\">9587068</a>). However, here is a more accessible figure from Marshall and colleagues (2013. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/23742999/\" rel=\"nofollow noreferrer\">23742999</a>):</p>\n<p><img src=\"https://ars.els-cdn.com/content/image/1-s2.0-S0196978113002003-gr1.jpg\" alt=\"Figure of Gastrin Production\" /></p>\n<p>^{Figure 1 from Marshal et al 2013 available <a href=\"https://doi.org/10.1016/j.peptides.2013.05.009\" rel=\"nofollow noreferrer\">here</a>.}</p>\n<p>As we can see, preprogastrin is converted to progastrin by the activity of a signal peptidase that removes the localization signal.</p>\n<h4>Prohormones</h4>\n<p>Prohormones are peptide hormones that have had their signal peptide removed. They need further modifications to become biologically active.</p>\n<p>Progastrin, like many other peptide hormones need further post-translational modifications including by sulfotransferases. Once these modifications are complete, the prohormones undergo proteolytic cleavage by peptidases to generate biologically active hormones. As a fun aside, there is some evidence that preprogastrin actually has a small amount of biologic activity (Dockray et al 2001. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/11181951/\" rel=\"nofollow noreferrer\">11181951</a>), so this further throws the distinction into disarray.</p>\n<h4>Prehormone</h4>\n<p>In contrast to peptide hormones, small molecule hormones like 25-OH vitamin D, are initially excreted as biologically inactive small molecules that require conversion in peripheral tissues (Vieth 2004. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/15225841/\" rel=\"nofollow noreferrer\">15225841</a>). With titles like <a href=\"https://pubmed.ncbi.nlm.nih.gov/15225841/\" rel=\"nofollow noreferrer\">&quot;Why &quot;Vitamin D&quot; is not a hormone&quot;</a>, you can see this is a touchy subject for some authors.</p>\n<p>The problem that Bryan Krause notes is that many authors seem to use prehormone and prohormone interchangeably for ultimate small molecule hormones.</p>\n" } ]

[ "https://health.stackexchange.com/questions/30980", "https://health.stackexchange.com", "https://health.stackexchange.com/users/24930/" ]

[ { "answer_id": 31052, "author": "MonsieurWave", "author_id": 22201, "author_profile": "https://health.stackexchange.com/users/22201", "pm_score": 1, "selected": false, "text": "<p>In certain cases an arterial line can be placed to allow continuous pressure monitoring.</p>\n<p>Tiru, B., J. A. Bloomstone, and W. T. McGee. &quot;Radial artery cannulation: a review article.&quot; J Anesth Clin Res 3.5 (2012): 1000209.</p>\n" }, { "answer_id": 31053, "author": "Ian Campbell", "author_id": 22190, "author_profile": "https://health.stackexchange.com/users/22190", "pm_score": 2, "selected": false, "text": "<p>Monitoring of patient blood pressure is vital because anesthesia and surgery can cause rapid changes in vital functions. Even brief periods of hypotension are associated with poor post-operative outcomes (Walsh <em>et al</em> 2013. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/23835589/\" rel=\"nofollow noreferrer\">23835589</a>).</p>\n<p>For the 80-90% of routine cases (Lam <em>et al</em> 2021. PMCID <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483407/\" rel=\"nofollow noreferrer\">8483407</a>), standard intermittent non-invasive blood pressure using <a href=\"https://en.wikipedia.org/wiki/Blood_pressure_measurement#Oscillometric\" rel=\"nofollow noreferrer\">oscillometry via brachial cuff</a> is sufficient. In these cases, oscillometry blood pressures show relatively good correlation with invasively obtained blood pressures. However, when patients begin exhibiting hypotension or hypertension, non-invasive blood pressures appear to systematically over- or under- estimate blood pressures, respectively (Lehman <em>et al</em> 2013. PMCID <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724452/\" rel=\"nofollow noreferrer\">3724452</a>).</p>\n<p>Thus, in the remaining 10-20% of cases, more acurate &quot;invasive&quot; blood pressure monitoring is implemented. One common procedure is radial artery catheterization where a plastic catheter is directly inserted into the artery. From here, blood pressure is transduced outside the body and converted into an electrical signal where it can be analyzed and continuously monitored (Saugel <em>et al</em> 2020. PMCID <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183114/\" rel=\"nofollow noreferrer\">7183114</a>).</p>\n<p><a href=\"https://i.stack.imgur.com/wduVo.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/wduVo.jpg\" alt=\"Image of a distal radial artery catheter insertion\" /></a>\n^{Image of a radial artery catheter adapted from Xiong <em>et al</em> 2022 (PMCID <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8905752/\" rel=\"nofollow noreferrer\">8905752</a>).}</p>\n<p>Patients are selected as needing continuous blood pressure monitoring when they are critically ill, have major comorbidities, or are undergoing a major or extended procedure.</p>\n<h4>In sum, in the United States, it is estimated that 10-20% of surgical procedures involve continuous invasive blood pressure monitoring.</h4>\n" } ]

[ "https://health.stackexchange.com/questions/31051", "https://health.stackexchange.com", "https://health.stackexchange.com/users/400/" ]

[ { "answer_id": 31157, "author": "Carey Gregory", "author_id": 805, "author_profile": "https://health.stackexchange.com/users/805", "pm_score": 2, "selected": false, "text": "<p>The FFPx standards refer to the efficiency of the mask and the minimum particle size it filters out:</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7248188/#:%7E:text=FFP1%20refers%20to%20the%20least,filtering%20mask%20of%20the%20FFPs\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7248188/#:~:text=FFP1%20refers%20to%20the%20least,filtering%20mask%20of%20the%20FFPs</a>.</p>\n<blockquote>\n<p>FFP1 refers to the least filtering of the three masks with an aerosol\nfiltration of at least 80% for 0.3 μm particles, and is mainly used as\nan environmental dust mask. FFP2 masks have a minimum of 94%\nfiltration percentage whilst FFP3 masks are the most filtering mask of\nthe FFPs. With a minimum filtration percentage of 99%, they protect\nagainst very fine particles such as asbestos.</p>\n</blockquote>\n<p>So FFP1s are simply dust masks, good for sanding in your workshop but not good for medical use. FFP2s are basically the N95/KN95/EN149 masks, and FFP3s are the N99 masks. The <a href=\"https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html#DifferentSituations\" rel=\"nofollow noreferrer\">general recommendations</a> from the US CDC for protection from COVID are the KN95/N95/EN149 masks, although N95 should be reserved for use by medical professionals.</p>\n" }, { "answer_id": 31158, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 1, "selected": false, "text": "<p>EN149:2001+A1:2009 and EN149:2001+A1:2010 are European standards, with the year of ammendments at the end. Unfortunately, like you, I cannot find a definitive answer to the difference without paying €83 = $88 = £70.</p>\n<p>The ammendments made in EN149:2001+A1:2009 are reviewed at <a href=\"https://icc-iso.org/index.php/en/certificates/58-maskat-en\" rel=\"nofollow noreferrer\">https://icc-iso.org/index.php/en/certificates/58-maskat-en</a></p>\n<blockquote>\n<p>This new classification involves changes and new performance requirements. The tests introduced partly aim to give the user additional confidence in the effectiveness of the respirators, ensuring continued protection of the respiratory tract even in particularly demanding environments. In addition, for respirators classified according to the new rules as &quot;reusable&quot;, to be able to repeat cleaning, storage and reuse between shifts.</p>\n</blockquote>\n<p>The site then goes into specifics on what the new requirements are, above the previous standard.</p>\n<blockquote>\n<p>The main innovations introduced are shown below:</p>\n<ol>\n<li>Disposable devices (product classification and marking 'NR').</li>\n</ol>\n<ul>\n<li>Climatic conditioning under altered conditions prior to testing.</li>\n<li>New efficiency test - a long-term extension of the previous penetration test.</li>\n<li>Optional test related to clogging requirements (product classification and marking &quot;D&quot;).</li>\n<li>Example of marking: EN 149:2001+A1:2009 FFP2 NR D</li>\n</ul>\n<ol start=\"2\">\n<li>Reusable devices (product classification and marking 'R'</li>\n</ol>\n<ul>\n<li>Conditioning under altered conditions before testing.</li>\n<li>New cleaning and sanitation tests of the product before penetration tests.</li>\n<li>New efficiency test - a long-term extension of the previous penetration test.</li>\n<li>New 24-hour post-exposure storage test.</li>\n<li>New penetration test to be repeated after storage.</li>\n<li>Mandatory test related to clogging requirements (product classification and marking &quot;D&quot;).</li>\n<li>Example of marking: EN 149:2001+A1:2009 FFP3 R D\nThe marking on the product must remain EN149:2001, but it must contain information\nif the product is disposable (NR) or reusable (R).</li>\n</ul>\n</blockquote>\n<p>Sadly, during the coronavirus pandemic the personal protective equipment (PPE) market is inundated with fake respirators claiming to be genuine. These fakes will pose a health risk to anyone wearing them because they will provide little protection against the coronavirus.</p>\n<p>Instructions for how to spot fake masks can be found at <a href=\"https://bda.org/advice/Coronavirus/Documents/spotting-fake-face-masks.pdf\" rel=\"nofollow noreferrer\">https://bda.org/advice/Coronavirus/Documents/spotting-fake-face-masks.pdf</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/31156", "https://health.stackexchange.com", "https://health.stackexchange.com/users/25208/" ]

[ { "answer_id": 31220, "author": "Carey Gregory", "author_id": 805, "author_profile": "https://health.stackexchange.com/users/805", "pm_score": 2, "selected": false, "text": "<p>Whether it's ethical or not is a moot question because in the US it would be illegal under federal law to do so unless the doctor has the patient's written permission to inform the others.</p>\n<p>The law that prohibits this is known as the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Specifically, the Privacy Rule of HIPAA identifies Protected Health Information (PHI) as follows:</p>\n<blockquote>\n<p><strong>Protected Health Information.</strong> The Privacy Rule protects all &quot;individually identifiable health information&quot; held or transmitted by\na covered entity or its business associate, in any form or media,\nwhether electronic, paper, or oral. The Privacy Rule calls this\ninformation &quot;protected health information (PHI).&quot;</p>\n</blockquote>\n<p><a href=\"https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html#:%7E:text=The%20Privacy%20Rule%20protects%20all,health%20information%20(PHI).%22\" rel=\"nofollow noreferrer\">Source</a></p>\n<p>The specific restriction is as follows (<em>same link, emphasis is mine</em>):</p>\n<blockquote>\n<p><strong>Basic Principle.</strong> A major purpose of the Privacy Rule is to define and limit the circumstances in which an individual’s protected heath\ninformation may be used or disclosed by covered entities. <strong>A covered\nentity may not use or disclose protected health information, except\neither: (1) as the Privacy Rule permits or requires; or (2) as the\nindividual who is the subject of the information (or the individual’s\npersonal representative) authorizes in writing.</strong></p>\n</blockquote>\n<p>Nowhere in the Privacy Rule does it permit informing family or cohabitants about infectious diseases -- or any PHI at all -- without the patient's permission.</p>\n" }, { "answer_id": 31228, "author": "Martin", "author_id": 25296, "author_profile": "https://health.stackexchange.com/users/25296", "pm_score": 0, "selected": false, "text": "<p>Failure of ethics for whom?</p>\n<ul>\n<li>If the contagious <strong>patient</strong> does not disclose the risk for her/his family (and fails to protect them otherwise), endangering their health is a clear unethical violation.</li>\n<li>For <strong>medical staff</strong>: at least depending on the jurisdiction, there are areas where all patient data is highly confidential unless the patients wants the medical staff to talk, with the exception of the patient directly endangering herself/himself or others. A classical examples is a patient in an altered mental state who cannot understand that driving quite is likely to kill himself or a child on the road, or a HIV positive patient who is not willing to inform and protect partners. This is always a balance of the thread to confidentiality vs. thread to life of the patient and third parties, and requires a real and direct danger that cannot be resolved otherwise. In these cases medical staff is allowed (and required) to prevent immanent danger, and if necessary break confidentiality - as much as really necessary.</li>\n</ul>\n<p>In addition, there are common obligations to tell about serious infections (depending on the disease for clinical practitioneer and/or diagnostic lab, either anonymously or by name), to allow health care authorities to monitor outbreaks and possibly take countermeasures for the endangered public.</p>\n<p>In cases of doubt and when time allows, fellow team members (e.g. your supervising professor, clinic attorney) or a medical ethics board my be involved in the decision.</p>\n<p>Regarding your example: if the disease causes substantial harm and is likely to be transmitted, it would be unethical (and unlawful depending on the jurisdiction) to force the family to suffer.</p>\n" } ]

[ "https://health.stackexchange.com/questions/31215", "https://health.stackexchange.com", "https://health.stackexchange.com/users/25276/" ]

[ { "answer_id": 31221, "author": "bob1", "author_id": 24128, "author_profile": "https://health.stackexchange.com/users/24128", "pm_score": 5, "selected": false, "text": "<p>In general, a <a href=\"https://en.wikipedia.org/wiki/Pandemic\" rel=\"nofollow noreferrer\">pandemic is a disease</a> that is spread across a large area. It is not based on case rates or anything similar, but rather on its global spread and potential threat to people. For example, you can visit this <a href=\"http://www.emro.who.int/pandemic-epidemic-diseases/outbreaks/index.html\" rel=\"nofollow noreferrer\">WHO EMRO site</a> and see a group of diseases that are currently in pandemic or considered pandemic potential. Note that in some of these diseases only a small handful of people are infected each year, and even fewer die. For a close comparison to COVID-19, caused by SARS-CoV-2, you can look at MERS (Middle East Respiratory Syndrome), which is caused by another coronavirus, <a href=\"https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome%E2%80%93related_coronavirus\" rel=\"nofollow noreferrer\">MERS-CoV</a>. For this disease, since the disease emerged, there have been <a href=\"https://applications.emro.who.int/docs/WHOEMCSR518E-eng.pdf\" rel=\"nofollow noreferrer\">2589 cases, with 893 deaths</a>. To quote the linked pdf, note the last bullet point!:</p>\n<blockquote>\n<ul>\n<li>At the end of March 2022, a total of 2589 laboratory-confirmed cases of\nMiddle East respiratory syndrome (MERS), including 893 associated deaths\n(case–fatality ratio of 34.5%) were reported globally. The majority of\nthese cases were reported from Saudi Arabia (2184 cases, including 813\nrelated deaths) with a case–fatality ratio of 37.2%.</li>\n</ul>\n</blockquote>\n<blockquote>\n<ul>\n<li>During the month of March 2022, one new case was reported.</li>\n</ul>\n</blockquote>\n<p>So, from this, we can see that there was 1 case in the past month, but still considered pandemic or pandemic potential.</p>\n<p>In the case of a comparison to influenza, the WHO has the same approach to this as they do to SARS-CoV-2, <a href=\"https://www.who.int/news/item/25-02-2022-recommendations-announced-for-influenza-vaccine-composition-for-the-2022-2023-northern-hemisphere-influenza-season\" rel=\"nofollow noreferrer\">creating/recommending vaccines</a> (I've worked on these personally at a <a href=\"https://www.who.int/initiatives/global-influenza-surveillance-and-response-system/who-collaboration-center-erl\" rel=\"nofollow noreferrer\">WHO collaborating center</a>), recommending treatments etc. However, sometimes, the various influenza viruses are not considered pandemic because they don't spread widely enough - this is particularly the case for things like the highly pathogenic <a href=\"https://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H5N1\" rel=\"nofollow noreferrer\">H5N1</a> subtype, which can cause pandemics in birds, but <a href=\"https://www.pnas.org/doi/10.1073/pnas.0605134103\" rel=\"nofollow noreferrer\">so far haven't caused sustained transmission</a>¹ in humans, though <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857285/\" rel=\"nofollow noreferrer\">local transmission does occur occasionally</a>². Occasionally a particular influenza spreads widely enough that it is considered a pandemic strain. A good example of this is the <a href=\"https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html\" rel=\"nofollow noreferrer\">2009 H1N1 pandemic strain</a>.</p>\n<p>Now, you are directly comparing influenza and COVID-19 in terms of deaths, remember that large parts of the world don't report their infections of anything properly because of lack of resources to do complete testing, lack of facilities, healthcare, politics, etc. The figures the WHO is reporting for case rates and deaths from SARS-CoV-2 infection are the confirmed ones, announced by the various governments. These are not estimates like the numbers provided for cases and fatalities in the influenza links you provided. It is highly likely that the SARS-CoV-2 case and fatality rates are much higher than reported given the conditions I mentioned above.</p>\n<p>In addition remember that those countries reporting those numbers are those with the resources to do so, and those countries tend to be relatively wealthy, and as a consequence also have high vaccination rates, which we know <a href=\"https://www.bmj.com/content/376/bmj-2021-069761\" rel=\"nofollow noreferrer\">drop infection and fatality rates significantly for SARS-CoV-2 infections</a> ³ (this is just one of many scientific studies showing the same thing). Without the vaccinations, cases and fatalities would be much higher than influenza. In real terms, unvaccinated COVID-19 has a infection fatality rate that is <a href=\"https://www.bmj.com/content/370/bmj.m3410/rr-6\" rel=\"nofollow noreferrer\">an order of magnitude higher than influenza</a>.</p>\n<p>So, basically COVID-19 is still a pandemic because it is still causing widespread infection and a lot of deaths worldwide, which is the definition of a pandemic.</p>\n<p>1: Maines TR, Chen LM, Matsuoka Y, Chen H, Rowe T, Ortin J, Falcón A, Nguyen TH, Mai le Q, Sedyaningsih ER, Harun S, Tumpey TM, Donis RO, Cox NJ, Subbarao K, Katz JM. Lack of transmission of H5N1 avian-human reassortant influenza viruses in a ferret model. Proc Natl Acad Sci U S A. 2006 Aug 8;103(32):12121-6. doi: 10.1073/pnas.0605134103. Epub 2006 Jul 31. PMID: 16880383; PMCID: PMC1567706.</p>\n<p>2: Yang, Y., Halloran, M. E., Sugimoto, J. D., &amp; Longini, I. M., Jr (2007). Detecting human-to-human transmission of avian influenza A (H5N1). Emerging infectious diseases, 13(9), 1348–1353. <a href=\"https://doi.org/10.3201/eid1309.070111\" rel=\"nofollow noreferrer\">https://doi.org/10.3201/eid1309.070111</a></p>\n<p>3: Lauring A S, Tenforde M W, Chappell J D, Gaglani M, Ginde A A, McNeal T et al. Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study BMJ 2022; 376 :e069761 doi:10.1136/bmj-2021-069761</p>\n" }, { "answer_id": 31223, "author": "terdon", "author_id": 222, "author_profile": "https://health.stackexchange.com/users/222", "pm_score": 4, "selected": false, "text": "<p>Whether an outbreak of a disease is classed as a <em>pandemic</em> or not has absolutely nothing to do with the number of deaths or any other measure of the virulence or danger presented by the disease. It is only and exclusively based on whether the disease is very widely spread across the human population. Here's the WHO's <a href=\"https://www.publichealth.com.ng/world-health-organization-who-pandemic-definition/\" rel=\"nofollow noreferrer\">own definition</a> of the term:</p>\n<blockquote>\n<p>an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.</p>\n</blockquote>\n<p>And in case you think that's somehow political, here's a <a href=\"https://www.merriam-webster.com/dictionary/pandemic\" rel=\"nofollow noreferrer\">dictionary definition</a>:</p>\n<blockquote>\n<p>: an outbreak of a disease that occurs over a wide geographic area (such as multiple countries or continents) and typically affects a significant proportion of the population : a pandemic outbreak of a disease</p>\n</blockquote>\n<p>As you can see, there is no mention of deaths or risks posed by the disease, or severity of symptoms or anything else other than geographic spread. This means that you could have a disease whose only symptom is a mild rash and which goes away after a single day and never ever kills anyone, but if it is widespread enough that would still be classed as a <em>pandemic</em>.</p>\n<p>So whether the disease is causing more or fewer deaths than another, or indeed whether it is causing any deaths at all, is completely irrelevant to whether it should be classed as a pandemic.</p>\n" }, { "answer_id": 31231, "author": "JonathanReez", "author_id": 7314, "author_profile": "https://health.stackexchange.com/users/7314", "pm_score": 2, "selected": false, "text": "<p>The WHO talked about this question long before COVID. In the article <a href=\"https://apps.who.int/iris/handle/10665/270942\" rel=\"nofollow noreferrer\">The classical definition of a pandemic is not elusive</a> published in the <em>Bulletin of the World Health Organization</em> in 2011, the following is said about why only the 2009 influenza wave was declared a <em>pandemic</em>:</p>\n<blockquote>\n<p>A pandemic is defined as “an epidemic occurring worldwide, or over a\nvery wide area, crossing international boundaries and usually\naffecting a large number of people”. The classical definition includes nothing about population immunity,\nvirology or disease severity. By this definition, pandemics can be\nsaid to occur annually in each of the temperate southern and northern\nhemispheres, given that seasonal epidemics cross international\nboundaries and affect a large number of people. However, seasonal\nepidemics are not considered pandemics.</p>\n<p>A true influenza pandemic\noccurs when almost simultaneous transmission takes place worldwide. In\nthe case of pandemic influenza A(H1N1), widespread transmission was\ndocumented in both hemispheres between April and September 2009.\nTransmission occurred early in the influenza season in the temperate\nsouthern hemisphere but out of season in the northern hemisphere. This\nout-of-season transmission is what characterizes an influenza\npandemic, as distinct from a pandemic due to another type of virus.\nSimultaneous worldwide transmission of influenza is sufficient to\ndefine an influenza pandemic and is consistent with the classical\ndefinition of “an epidemic occurring worldwide”.</p>\n</blockquote>\n<p>And further:</p>\n<blockquote>\n<p>It is tempting to surmise that the complicated pandemic definitions\nused by the World Health Organization (WHO) and the Centers for\nDisease Control and Prevention of the United States of America\ninvolved severity1,10 in a deliberate attempt to garner political\nattention and financial support for pandemic preparedness. As noted by\nDoshi, the perceived need for this support can be understood given\nconcerns about influenza A(H5N1) and the severe acute respiratory\nsyndrome (SARS). However, conflating spread and severity allowed the\nsuggestion that 2009 A(H1N1) was not a pandemic. It was, in fact, a\nclassical pandemic, only much less severe than many had anticipated or\nwere prepared to acknowledge, even as the evidence accumulated.</p>\n</blockquote>\n<p>So... when would COVID cease being a &quot;pandemic&quot;? Given the WHO's pre-COVID definition this should happen when we get at least a full year of predictable seasonal spread. Given that Omicron's wave spiked all around the world near-simultaneously in January 2022, the earliest this can happen is January 2023, after which it will be declared a seasonal virus similar to the influenza.</p>\n<p>It should of course be noted that the WHO's definition of a pandemic somewhat contradicts the layman understanding of what it means. I.e. the common expression <a href=\"https://www.google.com/search?q=the%20pandemic%20isn%27t%20over\" rel=\"nofollow noreferrer\">the pandemic is not over yet!</a> references the idea that we must take <em>pandemic</em> diseases seriously, as opposed to <em>endemic</em> or <em>non-pandemic</em> diseases like influenza or the common cold. Whether or not treating COVID <em>seriously</em> is important is a matter of debate, however technically speaking that's not what the WHO means by continuing to say that we're still in a pandemic.</p>\n" } ]

[ "https://health.stackexchange.com/questions/31219", "https://health.stackexchange.com", "https://health.stackexchange.com/users/7049/" ]

[ { "answer_id": 31276, "author": "Ian Campbell", "author_id": 22190, "author_profile": "https://health.stackexchange.com/users/22190", "pm_score": 3, "selected": true, "text": "<p>As Bryan Krause notes in the comments:</p>\n<blockquote>\n<p>The nutrition guidelines are based on some recommended intake of each nutrient, measured in mass. So if 100 mg of a substance is 20% of the recommendation, then 200 mg is 40%, etc.</p>\n</blockquote>\n<p>Another key piece of information that you may be missing is that <a href=\"https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx\" rel=\"nofollow noreferrer\">recommended daily allowances</a> are determined while taking into account the age, and sex specific absorption of the individual nutrient.</p>\n<p>For example, if the <a href=\"https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/\" rel=\"nofollow noreferrer\">RDA for calcium</a> for a 1 year old male is 700mg, that is taking into account the calcium absorption rate of a typical 1 year old male.</p>\n<p>As Bryan Krause mentioned:</p>\n<blockquote>\n<p>From a medical perspective it's rare that anything beyond [the RDA] matters. No one is achieving exactly 100% of every recommended nutrient every day, and until recently, human life has gotten on just fine without any such precision in diet - biology is quite flexible. The important medical cases are specific conditions and diets that are drastically outside the norm, and they're usually identified by symptoms, not by measuring uptake of particular nutrients.</p>\n</blockquote>\n" }, { "answer_id": 31277, "author": "Armatus", "author_id": 12506, "author_profile": "https://health.stackexchange.com/users/12506", "pm_score": 3, "selected": false, "text": "<p>I would add to the existing answer that this really boils down to which factors of nutrient uptake you want to ignore.</p>\n<p>You mention already that you don't want to be concerned with variation of the human digestive system.</p>\n<p>I guessed that meal size could be a factor too (a large meal being more likely to saturate uptake pathways), but apparently at least in laboratory dogs, it seems <a href=\"https://pubmed.ncbi.nlm.nih.gov/4038439/\" rel=\"noreferrer\">saturation is the norm regardless of meal size</a>. I couldn't find any more evidence on this topic, but I could imagine that this only holds for macronutrients. Though it's just as possible that micronutrient uptake pathways' capacities are scaled accordingly and are also saturated as soon as a meal contains any appreciable fraction of the nutrient's RDA.</p>\n<p>What about the influence of one compound contained in the meal on the uptake of another? E.g. <a href=\"https://pubmed.ncbi.nlm.nih.gov/21462112/\" rel=\"noreferrer\">Calcium reduces iron absorption</a>, while <a href=\"https://pubmed.ncbi.nlm.nih.gov/17693180/\" rel=\"noreferrer\">vitamin C increases it</a>. Zinc and iron <a href=\"https://pubmed.ncbi.nlm.nih.gov/3522825/\" rel=\"noreferrer\">compete for absorption</a>. Indigestible dietary fibre also affects the uptake of nutrients (<a href=\"https://pubmed.ncbi.nlm.nih.gov/34959832/\" rel=\"noreferrer\">carbohydrates shown e.g. here</a>, but as far as I am aware it's not just carbs).</p>\n<p>Of course, you can decide to simplify and just assume a linear intake/uptake relationship. Around the scale of the RDA, that's not an unreasonable simplification to make, and for consumer purposes we do make that assumption all the time. Other purposes will require more careful research and study conditions appropriate for specific nutrients.</p>\n" } ]

[ "https://health.stackexchange.com/questions/31275", "https://health.stackexchange.com", "https://health.stackexchange.com/users/25353/" ]

[ { "answer_id": 31339, "author": "Bryan Krause", "author_id": 8728, "author_profile": "https://health.stackexchange.com/users/8728", "pm_score": 3, "selected": false, "text": "<p>Every government is going to have their own regulations for this sort of thing.</p>\n<p>For the US, <a href=\"https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-206\" rel=\"nofollow noreferrer\">the law states</a>:</p>\n<blockquote>\n<p>Unless exempted under § 206.7, no drug product in solid oral dosage form may be introduced or delivered for introduction into interstate commerce unless it is clearly marked or imprinted with a code imprint that, in conjunction with the product's size, shape, and color, permits the unique identification of the drug product and the manufacturer or distributor of the product. Identification of the drug product requires identification of its active ingredients and its dosage strength. Inclusion of a letter or number in the imprint, while not required, is encouraged as a more effective means of identification than a symbol or logo by itself. Homeopathic drug products are required only to bear an imprint that identifies the manufacturer and their homeopathic nature.</p>\n</blockquote>\n<p>In summary, you need to be able to ID a pill based on it's size, shape, color, and label. Anything else may be allowed but is not required.</p>\n<p>I think if you printed a long name there would be serious limits on the possible font size, and this would make the pill difficult to identify. An abbreviation could easily be confused for a different drug; much safer for someone to have a pill that they can't identify and know they can't identify, than to have a pill that they think they've identified correctly but are actually wrong because they misunderstood the abbreviation intended.</p>\n<p>Note also the requirement to identify &quot;manufacturer or distributor of the product&quot; - while you might think it would be more convenient for all manufacturers to have the same appearance for the same drug, that's not necessarily good from a regulatory perspective, where it may be very important that a pill can be identified as coming from a particular source if it is found to be contaminated or otherwise not conforming to specifications.</p>\n" }, { "answer_id": 31365, "author": "allo", "author_id": 25442, "author_profile": "https://health.stackexchange.com/users/25442", "pm_score": 2, "selected": false, "text": "<p>A few answers compiled from the comments, which are no own answers yet:</p>\n<p>Links:</p>\n<ul>\n<li><a href=\"https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-206\" rel=\"nofollow noreferrer\">The regulations the require pill imprinting</a></li>\n<li><a href=\"https://www.pharmacytimes.com/view/2006-03-5374\" rel=\"nofollow noreferrer\">The Evolution of Imprint Identification</a></li>\n<li><a href=\"https://www.drugs.com/pill_identification.html\" rel=\"nofollow noreferrer\">Pill Identifier by drugs.com</a></li>\n</ul>\n<p>Ideas:</p>\n<ul>\n<li>Some pills have an imprint that actually makes them identifiable but it is too small for reading without magnification</li>\n<li>Indentions on a pill make it more likely to crumble.</li>\n<li>Some pills have numbers that together with the shape yield good search results, e.g., on Google.</li>\n<li>One usually wouldn't take a lost and found pill anymore.</li>\n<li>There just is not enough place for, e.g., a full name. This would not prevent using a short unique code, though.</li>\n</ul>\n<p>From the comments it also looks a bit like pills in <a href=\"https://upload.wikimedia.org/wikipedia/commons/2/28/Aspirin1.jpg\" rel=\"nofollow noreferrer\">American pill bottles</a> may have more often <em>have</em> an imprint than ones in <a href=\"https://upload.wikimedia.org/wikipedia/commons/9/9c/Lamictal-Tabletten.jpg\" rel=\"nofollow noreferrer\">Blister packages</a> which are more common in Europe which usually contain the name on the foil.</p>\n" } ]

[ "https://health.stackexchange.com/questions/31338", "https://health.stackexchange.com", "https://health.stackexchange.com/users/25442/" ]

[ { "answer_id": 31359, "author": "Bryan Krause", "author_id": 8728, "author_profile": "https://health.stackexchange.com/users/8728", "pm_score": 4, "selected": true, "text": "<p>From <em>Chauhan, V. M., Zhang, H., Dalby, P. A., &amp; Aylott, J. W. (2020). Advancements in the co-formulation of biologic therapeutics. Journal of Controlled Release, 327, 397-405.</em>:</p>\n<blockquote>\n<p>Co-formulation can be considered as the purist view of a combination therapy and can be described as consisting of more than one drug substance in a single formulation, with the intention of delivering multiple therapeutic agents at the same time for maximum therapeutic benefit</p>\n</blockquote>\n<p>Co-formulated in the context of a therapeutic drug/treatment means that two or more components are part of the same combined treatment, for example existing in the same pill or solution for injection. In this form, they are not separable.</p>\n<p>It's not clear to me that this is specifically what the chart you linked means, though, rather they are saying that some treatment options have not been compared independent of the others, but were always given together within trials. That might be better described as &quot;co-administered&quot;.</p>\n<p>From the context of the flow chart, it is not immediately clear to me which specific combinations they are referring to.</p>\n" }, { "answer_id": 31368, "author": "Jacob", "author_id": 25475, "author_profile": "https://health.stackexchange.com/users/25475", "pm_score": -1, "selected": false, "text": "<p>In this context, they're saying that the only combination therapies that have been been tested for efficacy are those that those contained in products that have been explicitly produced and released as a single product.</p>\n<p>I believe in context they're making the point that while Paxlovid and Evusheld are combination therapy products, they have explicitly been tested for efficacy. One shouldn't see that Paxlovid is a dual-therapy antiviral and conclude that administering some other combination of antiviral medications would be more effective than a single antiviral alone.</p>\n" }, { "answer_id": 31370, "author": "user237650", "author_id": 8593, "author_profile": "https://health.stackexchange.com/users/8593", "pm_score": 1, "selected": false, "text": "<blockquote>\n<p><strong>There is currently no evidence available on the effectiveness of concurrent use of monoclonal antibodies or antivirals for Covid-19, except when co-formulated.</strong></p>\n</blockquote>\n<p>As they have used <strong>or</strong>, I think they are trying to say that no evidence is available for taking two different antivirals together(except the co-administered Nimratrelvir/Ritonavir) or two different monoclonal antibodies together except when they are co-formulated i.e. Evusheld.</p>\n<p>A similar type of wording is used by them in the sourced page below, from where I think they have created the flowchart.</p>\n<blockquote>\n<p>The concurrent use of two or more monoclonal antibodies should be avoided except where co-formulated.</p>\n</blockquote>\n<p><strong>Source:</strong>\n<a href=\"https://covid19evidence.net.au/#living-guidelines\" rel=\"nofollow noreferrer\">https://covid19evidence.net.au/#living-guidelines</a>\n(See Evusheld section)</p>\n" } ]

[ "https://health.stackexchange.com/questions/31358", "https://health.stackexchange.com", "https://health.stackexchange.com/users/20431/" ]

[ { "answer_id": 31359, "author": "Bryan Krause", "author_id": 8728, "author_profile": "https://health.stackexchange.com/users/8728", "pm_score": 4, "selected": true, "text": "<p>From <em>Chauhan, V. M., Zhang, H., Dalby, P. A., &amp; Aylott, J. W. (2020). Advancements in the co-formulation of biologic therapeutics. Journal of Controlled Release, 327, 397-405.</em>:</p>\n<blockquote>\n<p>Co-formulation can be considered as the purist view of a combination therapy and can be described as consisting of more than one drug substance in a single formulation, with the intention of delivering multiple therapeutic agents at the same time for maximum therapeutic benefit</p>\n</blockquote>\n<p>Co-formulated in the context of a therapeutic drug/treatment means that two or more components are part of the same combined treatment, for example existing in the same pill or solution for injection. In this form, they are not separable.</p>\n<p>It's not clear to me that this is specifically what the chart you linked means, though, rather they are saying that some treatment options have not been compared independent of the others, but were always given together within trials. That might be better described as &quot;co-administered&quot;.</p>\n<p>From the context of the flow chart, it is not immediately clear to me which specific combinations they are referring to.</p>\n" }, { "answer_id": 31368, "author": "Jacob", "author_id": 25475, "author_profile": "https://health.stackexchange.com/users/25475", "pm_score": -1, "selected": false, "text": "<p>In this context, they're saying that the only combination therapies that have been been tested for efficacy are those that those contained in products that have been explicitly produced and released as a single product.</p>\n<p>I believe in context they're making the point that while Paxlovid and Evusheld are combination therapy products, they have explicitly been tested for efficacy. One shouldn't see that Paxlovid is a dual-therapy antiviral and conclude that administering some other combination of antiviral medications would be more effective than a single antiviral alone.</p>\n" }, { "answer_id": 31370, "author": "user237650", "author_id": 8593, "author_profile": "https://health.stackexchange.com/users/8593", "pm_score": 1, "selected": false, "text": "<blockquote>\n<p><strong>There is currently no evidence available on the effectiveness of concurrent use of monoclonal antibodies or antivirals for Covid-19, except when co-formulated.</strong></p>\n</blockquote>\n<p>As they have used <strong>or</strong>, I think they are trying to say that no evidence is available for taking two different antivirals together(except the co-administered Nimratrelvir/Ritonavir) or two different monoclonal antibodies together except when they are co-formulated i.e. Evusheld.</p>\n<p>A similar type of wording is used by them in the sourced page below, from where I think they have created the flowchart.</p>\n<blockquote>\n<p>The concurrent use of two or more monoclonal antibodies should be avoided except where co-formulated.</p>\n</blockquote>\n<p><strong>Source:</strong>\n<a href=\"https://covid19evidence.net.au/#living-guidelines\" rel=\"nofollow noreferrer\">https://covid19evidence.net.au/#living-guidelines</a>\n(See Evusheld section)</p>\n" } ]

[ "https://health.stackexchange.com/questions/31376", "https://health.stackexchange.com", "https://health.stackexchange.com/users/25499/" ]

[ { "answer_id": 31411, "author": "Clay Nichols", "author_id": 6607, "author_profile": "https://health.stackexchange.com/users/6607", "pm_score": 3, "selected": true, "text": "<p><a href=\"https://www.cdc.gov/niosh/emres/longhourstraining/clock.html\" rel=\"nofollow noreferrer\">From the CDC</a>\nThe circadian rhythm is reset from the eye.</p>\n<p><a href=\"https://i.stack.imgur.com/FsIEd.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/FsIEd.png\" alt=\"enter image description here\" /></a></p>\n" }, { "answer_id": 31582, "author": "Asklepian", "author_id": 25774, "author_profile": "https://health.stackexchange.com/users/25774", "pm_score": 3, "selected": false, "text": "<p>Circadian rhythm maintenance begins with <a href=\"https://en.wikipedia.org/wiki/Intrinsically_photosensitive_retinal_ganglion_cell\" rel=\"noreferrer\">intrinsically photosensitive retinal ganglion cells (ipRGC's)</a>. In the retina, you have the traditional rod and cone cells that are responsible for vision. However, you also have ipRGC's that are sensitive to blue light. These cells connect to the <a href=\"https://en.wikipedia.org/wiki/Suprachiasmatic_nucleus\" rel=\"noreferrer\">suprachiasmatic nucleus</a> in the <a href=\"https://en.wikipedia.org/wiki/Hypothalamus\" rel=\"noreferrer\">hypothalamus</a>. Every day, when your ipRGC's stop receiving blue light, your suprachiasmatic nucleus receives less stimulation and it signals the pineal gland to begin secreting melatonin, the sleep hormone, and a little while later you sleep. After some time, your <a href=\"https://en.wikipedia.org/wiki/Pineal_gland\" rel=\"noreferrer\">pineal gland</a> stops secreting <a href=\"https://en.wikipedia.org/wiki/Melatonin\" rel=\"noreferrer\">melatonin</a> and you wake back up.</p>\n<p>While you're awake, blue light from sunlight stimulates your hypothalamus NOT to stimulate your pineal gland to release melatonin so you don't get sleepy. This blue light input sets your body's circadian rhythm naturally every day.</p>\n<p>There is enough blue light in cloudy weather to set your circadian rhythm. However, certain conditions like <a href=\"https://en.wikipedia.org/wiki/Seasonal_affective_disorder\" rel=\"noreferrer\">Seasonal Affective Disorder (SAD)</a> can leave certain people feeling crummy when the days get shorter at the end of the year. As a result, you can buy <a href=\"https://en.wikipedia.org/wiki/Light_therapy#Mood_and_sleep_related\" rel=\"noreferrer\">light therapy lamps</a> to increase your blue light stimulation if you feel your environmental conditions aren't keeping your circadian rhythm where you'd like it to be.</p>\n" } ]

[ "https://health.stackexchange.com/questions/31410", "https://health.stackexchange.com", "https://health.stackexchange.com/users/6607/" ]

[ { "answer_id": 31859, "author": "David West", "author_id": 26181, "author_profile": "https://health.stackexchange.com/users/26181", "pm_score": 5, "selected": true, "text": "<p>No.</p>\n<p>No, no, no.</p>\n<p>Covid face masks help prevent contagious disease. They are not meant for anything else. Period. End of public health announcement.</p>\n<p>To be clear, N95 facemasks are particulate respirators. They do not protect against organic vapors, carcinogenic or otherwise.</p>\n<p>The posed question becomes complex with the inclusion of extensive background material, references, and opinions. Of note, the research excludes mask specifications. The discussion conflates the foundational concepts of smoke and vapor. The conclusion quotes the CDC, summarizes the authoritative and comprehensive guidance of the New York State Department of Health, and then goes on to remark &quot;but that was not very helpful.&quot;</p>\n<p>It is hoped that this reply will dispel many of the myths making the public think that these new face masks will now keep them safe from anything and everything dangerous in the air. It's just not true, and it's dangerous when folks believe or imply otherwise.</p>\n<p>Although N95 masks are required by OSHA for people who work in specific smoke environments and have helped a lot of regular folks who live in wildfire zones, they CAN NOT filter commonly co-present carcinogenic compounds in the kitchen or anywhere else.</p>\n<p>As requested in the question, the above remarks are provided to clarify by promoting trust in the American institutions empowered to provide reliable, factual answers to public health questions such as yours.</p>\n" }, { "answer_id": 31861, "author": "zombiefeeder", "author_id": 26205, "author_profile": "https://health.stackexchange.com/users/26205", "pm_score": 3, "selected": false, "text": "<p><strong>TL;DR</strong> - The specific answer is &quot;NO, N95 masks cannot reliably protect one from the questioned chemicals/compounds&quot;. But there's so much more to consider...</p>\n<p>This supplemental answer is more broad than the specific, misguided focus on N95 masks. That's not meant to insult, it's meant as recognition of the complexity of the world of safety controls, of which N95 masks are a small part. Even seasoned safety officers, like myself, find that protecting others from myriad dangers is an arduous task requiring years of study, intense application analyses, and quite a lot of human psychology application. Without a good understanding of safety principles, an internet search and a few articles will likely confuse and lead one astray.</p>\n<p><strong>N95 Masks</strong></p>\n<p>At the very base of the question, any protective mask must be appropriate to the application. &quot;N95 mask&quot; is actually a broad category; there are numerous types of N95 masks created for their specific use. Assuming the question is referencing the type of N95 masks made popular by the COVID-19 pandemic and CDC response, these are masks specific to medical/biological protection applications; they should not be assumed effective in any other application, be it chemical vapors, smoke, radiologics, even other novel biologics for which they have not been specifically tested and approved. In short, if the mask is not made, tested, and approved for the application, then one really has no idea whether it will work.</p>\n<p>Even if one has determined a correct mask/respirator type, one still needs to assure that the manufacturer and seller are legitimate. The COVID-19 pandemic and resulting supply glut brought numerous counterfeit masks to the supply chain. <a href=\"https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html\" rel=\"noreferrer\">https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html</a>.</p>\n<p><strong>Research</strong></p>\n<p>Another issue with gaining knowledge from internet sources is a misunderstanding of the research process. Research articles may be published, later refuted, found to be flawed with additional research, found to be biased leading to inaccurate conclusions, or may be built upon by additional research and generally accepted as accurate. This is what professional organizations such as CDC, NIOSH, and many others do - they understand the research and apply it appropriately for the world. This process takes years, and is not perfect (because humans are not perfect).</p>\n<p>The given research articles generally <em>suggest</em> that frying foods is likely a threat to health. But this needs to be supported by additional research to say how much threat exists, for whom, in what amounts, for what exposure time, and more. Not to mention the relative harm of actually eating the foods discussed. Research additionally needs to support our understanding of appropriate mitigation methods with which the following might help in a general way.</p>\n<p><strong>Hazard Controls</strong></p>\n<p>While the question focuses on masks, a component of Personal Protective Equipment (PPE), one must understand that PPE is the least effective of safety controls. We use it in hospital settings simply because other, more effective controls are impossible or impractical. See the Safety Controls Hierarchy below from National Institute for Occupational Safety and Health (NIOSH) at <a href=\"https://www.cdc.gov/niosh/topics/hierarchy/default.html\" rel=\"noreferrer\">https://www.cdc.gov/niosh/topics/hierarchy/default.html</a> :</p>\n<p><a href=\"https://i.stack.imgur.com/qEmsb.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/qEmsb.jpg\" alt=\"NIOSH Hierarchy of Hazard Controls\" /></a></p>\n<p>Simply as a comparative use of the Hierarchy - in hospitals, we cannot eliminate our infectious patients or substitute them for something benign. But we can use the latter three of the hierarchy:</p>\n<p><strong>Engineering</strong> - we physically isolate particularly infectious patients in rooms with negative airflow.</p>\n<p><strong>Administrative</strong> - hospitals have policies and procedures, based on supportive research and professional organization known best practices, to direct employees in working safely with infectious patients.</p>\n<p><strong>PPE</strong> - we wear use-specific masks, gowns, gloves, shoe covers, head covers, hoods, supplied-air respirators, and other PPE as called for by known best practice for the specific infectious agent. This is the last line of defense against transmission of infection from patient to worker.</p>\n<p>Applying the Hierarchy of Controls to the specific cooking situation is absolutely appropriate and would be more effective than using a single component (N95 masks) of a single point of the hierarchy (PPE). Suggestions:</p>\n<p><strong>Elimination</strong> - Remove oils, stoves, and frying pans from your house. Not really practical, as this only leads to substitution because &quot;a man's gotta eat&quot; (Trailer Park Boys - Randy).</p>\n<p><strong>Substitution</strong> - Cook and eat something different than fried foods. Use a different cooking method that does not involve frying. Eat food known/believed to be more healthy than fried foods. Safety isn't always as fun as doing whatever the heck one wants, but one needs to prioritize. This is also where the human psychology component of safety comes in - I know most people won't eliminate fried foods from their diets, so let's look at some realistic alternatives.</p>\n<p><strong>Engineering</strong> - Each of us probably already has a hood fan over our stove, but does it vent to the outside? Many don't (in U.S. at least). Is it really effective? Could we open a few windows to help clearing of the smoke/chemicals? Have we changed your hood filters according to manufacturer's recommendations? Could we do most or all of the frying outside? A hood fan will not be completely effective, but can be an important component in our safety controls, especially in commercial applications. This also brings up the question of harm to others if we vent to the outside on a commercial scale, i.e., are we just protecting the workers at the expense of innocent others?</p>\n<p><strong>Administrative</strong> - As the administrator of our households, we may set rules for all who cook so that appropriate safety controls will be followed. As the administrator of a restaurant or other commercial food production, one may require, through policy, engineering controls and worker safety procedures.</p>\n<p><strong>PPE</strong> - I think that masks are not necessarily a bad idea for use in cooking, but the mask needs to be the correct type for the given safety hazard else it is a waste of time and money. A few chemicals/compounds were mentioned in the question and each must be accounted for when choosing the correct protection. As a reference, this 3M site details their products appropriate for use in specific applications with specific chemicals: <a href=\"https://www.3m.com/3M/en_US/respiratory-protection-us/applications/\" rel=\"noreferrer\">https://www.3m.com/3M/en_US/respiratory-protection-us/applications/</a> Please note that, although I have received some training from 3M, I am not employed by nor a representative of, and I do not receive compensation from 3M. I am also not specifically recommending their products as there are several other PPE manufacturers with comparable products.</p>\n<p>As one finds the respirator/filter types appropriate for exposure to such things as benzopyrenes and formaldehyde as mentioned in the question, one will also likely decide they are not practical (cost and comfort) for personal use, but might be appropriate for daily exposure at a commercial level. Note that assessment of the amount and exposure time of the hazard is necessary to determine how often filters need to be replaced.</p>\n<p><strong>Final Notes</strong></p>\n<p>We cannot answer the general question of whether N95 masks protect one from cooking chemicals; the question is much too broad. However, I am inclined to opine &quot;<em>heck no</em>&quot;.</p>\n<p>If one is questioning appropriate mask use in a commercial setting, this raises all sorts of legal issues that I am not about to address. Leave those issues to those who regulate the industry in question. Although, I will note that workers generally have a right in the U.S. to voluntarily wear PPE at their own expense - see OSHA standards for details.</p>\n<p>@David West had a great answer. I'm just giving supplemental information for those who may come across this question in the future.</p>\n" } ]

[ "https://health.stackexchange.com/questions/31856", "https://health.stackexchange.com", "https://health.stackexchange.com/users/26177/" ]