StemCell Therapy

Diabetes mellitus type2 (formerly noninsulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes) is a metabolic disorder that is characterized by hyperglycemia (high blood sugar) in the context of insulin resistance and relative lack of insulin.[2] This is in contrast to diabetes mellitus type1, in which there is an absolute lack of insulin due to breakdown of islet cells in the pancreas.[3] The classic symptoms are excess thirst, frequent urination, and constant hunger. Type2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes. Obesity is thought to be the primary cause of type2 diabetes in people who are genetically predisposed to the disease (although this is not the case in people of East-Asian ancestry).

Type2 diabetes is initially managed by increasing exercise and dietary changes. If blood sugar levels are not adequately lowered by these measures, medications such as metformin or insulin may be needed. In those on insulin, there is typically the requirement to routinely check blood sugar levels.

Rates of type2 diabetes have increased markedly since 1960 in parallel with obesity. As of 2010 there were approximately 285million people diagnosed with the disease compared to around 30million in 1985.[4][5] Type 2 diabetes is typically a chronic disease associated with a ten-year-shorter life expectancy.[4] Long-term complications from high blood sugar can include heart disease, strokes, diabetic retinopathy where eyesight is affected, kidney failure which may require dialysis, and poor blood flow in the limbs leading to amputations. The acute complication of ketoacidosis, a feature of type1 diabetes, is uncommon,[6] however hyperosmolar hyperglycemic state may occur.

The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss.[7] Other symptoms that are commonly present at diagnosis include a history of blurred vision, itchiness, peripheral neuropathy, recurrent vaginal infections, and fatigue.[3] Many people, however, have no symptoms during the first few years and are diagnosed on routine testing.[3] People with type2 diabetes mellitus may rarely present with hyperosmolar hyperglycemic state (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).[3]

Type 2 diabetes is typically a chronic disease associated with a ten-year-shorter life expectancy.[4] This is partly due to a number of complications with which it is associated, including: two to four times the risk of cardiovascular disease, including ischemic heart disease and stroke; a 20-fold increase in lower limb amputations, and increased rates of hospitalizations.[4] In the developed world, and increasingly elsewhere, type2diabetes is the largest cause of nontraumatic blindness and kidney failure.[8] It has also been associated with an increased risk of cognitive dysfunction and dementia through disease processes such as Alzheimer's disease and vascular dementia.[9] Other complications include acanthosis nigricans, sexual dysfunction, and frequent infections.[7]

The development of type2 diabetes is caused by a combination of lifestyle and genetic factors.[8][10] While some of these factors are under personal control, such as diet and obesity, other factors are not, such as increasing age, female gender, and genetics.[4] A lack of sleep has been linked to type2 diabetes.[11] This is believed to act through its effect on metabolism.[11] The nutritional status of a mother during fetal development may also play a role, with one proposed mechanism being that of altered DNA methylation.[12]

A number of lifestyle factors are known to be important to the development of type2 diabetes, including obesity and being overweight (defined by a body mass index of greater than 25), lack of physical activity, poor diet, stress, and urbanization.[4][13] Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60-80% of cases in those of European and African descent, and 100% of cases in Pima Indians and Pacific Islanders.[3] Those who are not obese often have a high waisthip ratio.[3]

Dietary factors also influence the risk of developing type2 diabetes. Consumption of sugar-sweetened drinks in excess is associated with an increased risk.[14][15] The type of fats in the diet are also important, with saturated fats and trans fatty acids increasing the risk, and polyunsaturated and monounsaturated fat decreasing the risk.[10] Eating lots of white rice appears to also play a role in increasing risk.[16] A lack of exercise is believed to cause 7% of cases.[17]Persistent organic pollutants may also play a role.[18]

Most cases of diabetes involve many genes, with each being a small contributor to an increased probability of becoming a type2 diabetic.[4] If one identical twin has diabetes, the chance of the other developing diabetes within his lifetime is greater than 90%, while the rate for nonidentical siblings is 2550%.[3] As of 2011, more than 36genes had been found that contribute to the risk of type2 diabetes.[19] All of these genes together still only account for 10% of the total heritable component of the disease.[19] The TCF7L2 allele, for example, increases the risk of developing diabetes by 1.5times and is the greatest risk of the common genetic variants.[3] Most of the genes linked to diabetes are involved in beta cell functions.[3]

There are a number of rare cases of diabetes that arise due to an abnormality in a single gene (known as monogenic forms of diabetes or "other specific types of diabetes").[3][4] These include maturity onset diabetes of the young (MODY), Donohue syndrome, and Rabson-Mendenhall syndrome, among others.[4] Maturity onset diabetes of the young constitute 15% of all cases of diabetes in young people.[20]

There are a number of medications and other health problems that can predispose to diabetes.[21] Some of the medications include: glucocorticoids, thiazides, beta blockers, atypical antipsychotics,[22] and statins.[23] Those who have previously had gestational diabetes are at a higher risk of developing type2 diabetes.[7] Other health problems that are associated include: acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma, and certain cancers such as glucagonomas.[21]Testosterone deficiency is also associated with type2 diabetes.[24][25]

Type2 diabetes is due to insufficient insulin production from beta cells in the setting of insulin resistance.[3] Insulin resistance, which is the inability of cells to respond adequately to normal levels of insulin, occurs primarily within the muscles, liver, and fat tissue.[26] In the liver, insulin normally suppresses glucose release. However, in the setting of insulin resistance, the liver inappropriately releases glucose into the blood.[4] The proportion of insulin resistance versus beta cell dysfunction differs among individuals, with some having primarily insulin resistance and only a minor defect in insulin secretion and others with slight insulin resistance and primarily a lack of insulin secretion.[3]

Other potentially important mechanisms associated with type2 diabetes and insulin resistance include: increased breakdown of lipids within fat cells, resistance to and lack of incretin, high glucagon levels in the blood, increased retention of salt and water by the kidneys, and inappropriate regulation of metabolism by the central nervous system.[4] However, not all people with insulin resistance develop diabetes, since an impairment of insulin secretion by pancreatic beta cells is also required.[3]

The World Health Organization definition of diabetes (both type1 and type2) is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either:[29]

A random blood sugar of greater than 11.1mmol/l (200mg/dL) in association with typical symptoms[7] or a glycated hemoglobin (HbA1c) of 48mmol/mol (6.5 DCCT%) is another method of diagnosing diabetes.[4] In 2009 an International Expert Committee that included representatives of the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) recommended that a threshold of 48mmol/mol (6.5 DCCT%) should be used to diagnose diabetes.[30] This recommendation was adopted by the American Diabetes Association in 2010.[31] Positive tests should be repeated unless the person presents with typical symptoms and blood sugars >11.1mmol/l (>200mg/dl).[30]

Threshold for diagnosis of diabetes is based on the relationship between results of glucose tolerance tests, fasting glucose or HbA1c and complications such as retinal problems.[4] A fasting or random blood sugar is preferred over the glucose tolerance test, as they are more convenient for people.[4] HbA1c has the advantages that fasting is not required and results are more stable but has the disadvantage that the test is more costly than measurement of blood glucose.[32] It is estimated that 20% of people with diabetes in the United States do not realize that they have the disease.[4]

Diabetes mellitus type2 is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.[2] This is in contrast to diabetes mellitus type 1 in which there is an absolute insulin deficiency due to destruction of [islet cells in the pancreas and gestational diabetes mellitus that is a new onset of high blood sugars associated with pregnancy.[3] Type1 and type2 diabetes can typically be distinguished based on the presenting circumstances.[30] If the diagnosis is in doubt antibody testing may be useful to confirm type1 diabetes and C-peptide levels may be useful to confirm type2 diabetes,[33] with C-peptide levels normal or high in type2 diabetes, but low in type1 diabetes.[34]

No major organization recommends universal screening for diabetes as there is no evidence that such a program improve outcomes.[35][36] Screening is recommended by the United States Preventive Services Task Force (USPSTF) in adults without symptoms whose blood pressure is greater than 135/80mmHg.[37] For those whose blood pressure is less, the evidence is insufficient to recommend for or against screening.[37] There is no evidence that it changes the risk of death in this group of people.[38]

The World Health Organization recommends testing those groups at high risk[35] and in 2014 the USPSTF is considering a similar recommendation.[39] High-risk groups in the United States include: those over 45 years old; those with a first degree relative with diabetes; some ethnic groups, including Hispanics, African-Americans, and Native-Americans; a history of gestational diabetes; polycystic ovary syndrome; excess weight; and conditions associated with metabolic syndrome.[7] The American Diabetes Association recommends screening those who have a BMI over 25 (in people of Asian descent screening is recommending for a BMI over 23.[40]

Onset of type2 diabetes can be delayed or prevented through proper nutrition and regular exercise.[41][42] Intensive lifestyle measures may reduce the risk by over half.[8][43] The benefit of exercise occurs regardless of the person's initial weight or subsequent weight loss.[44] Evidence for the benefit of dietary changes alone, however, is limited,[45] with some evidence for a diet high in green leafy vegetables[46] and some for limiting the intake of sugary drinks.[14] In those with impaired glucose tolerance, diet and exercise either alone or in combination with metformin or acarbose may decrease the risk of developing diabetes.[8][47] Lifestyle interventions are more effective than metformin.[8] While low vitamin D levels are associated with an increased risk of diabetes, correcting the levels by supplementing vitamin D3 does not improve that risk.[48]

Management of type2 diabetes focuses on lifestyle interventions, lowering other cardiovascular risk factors, and maintaining blood glucose levels in the normal range.[8] Self-monitoring of blood glucose for people with newly diagnosed type2 diabetes may be used in combination with education,[49] however the benefit of self monitoring in those not using multi-dose insulin is questionable.[8][50] In those who do not want to measure blood levels, measuring urine levels may be done.[49] Managing other cardiovascular risk factors, such as hypertension, high cholesterol, and microalbuminuria, improves a person's life expectancy.[8] Decreasing the systolic blood pressure to less than 140mmHg is associated with a lower risk of death and better outcomes.[51] Intensive blood pressure management (less than 130/80mmHg) as opposed to standard blood pressure management (less than 140/85100mmHg) results in a slight decrease in stroke risk but no effect on overall risk of death.[52]

Intensive blood sugar lowering (HbA1c<6%) as opposed to standard blood sugar lowering (HbA1c of 77.9%) does not appear to change mortality.[53][54] The goal of treatment is typically an HbA1c of around 7% or a fasting glucose of less than 7.2mmol/L (130mg/dL); however these goals may be changed after professional clinical consultation, taking into account particular risks of hypoglycemia and life expectancy.[55][56] It is recommended that all people with type2 diabetes get regular ophthalmology examination.[3] Treating gum disease in those with diabetes may result in a small improvement in blood sugar levels.[57]

A proper diet and exercise are the foundations of diabetic care,[7] with a greater amount of exercise yielding better results.[58]Aerobic exercise leads to a decrease in HbA1c and improved insulin sensitivity.[58]Resistance training is also useful and the combination of both types of exercise may be most effective.[58] A diabetic diet that promotes weight loss is important.[59] While the best diet type to achieve this is controversial,[59] a low glycemic index diet or low carbohydrate diet has been found to improve blood sugar control.[60][61] Culturally appropriate education may help people with type2 diabetes control their blood sugar levels, for up to six months at least.[62] If changes in lifestyle in those with mild diabetes has not resulted in improved blood sugars within six weeks, medications should then be considered.[7] There is not enough evidence to determine if lifestyle interventions affect mortality in those who already have DM2.[43]

There are several classes of anti-diabetic medications available. Metformin is generally recommended as a first line treatment as there is some evidence that it decreases mortality;[8] however, this conclusion is questioned.[63] Metformin should not be used in those with severe kidney or liver problems.[7]

A second oral agent of another class or insulin may be added if metformin is not sufficient after three months.[55] Other classes of medications include: sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, SGLT2 inhibitors, and glucagon-like peptide-1 analog.[55] There is no significant difference between these agents.[55]Rosiglitazone, a thiazolidinedione, has not been found to improve long-term outcomes even though it improves blood sugar levels.[64] Additionally it is associated with increased rates of heart disease and death.[65]Angiotensin-converting enzyme inhibitors (ACEIs) prevent kidney disease and improve outcomes in those with diabetes.[66][67] The similar medications angiotensin receptor blockers (ARBs) do not.[67]

Injections of insulin may either be added to oral medication or used alone.[8] Most people do not initially need insulin.[3] When it is used, a long-acting formulation is typically added at night, with oral medications being continued.[7][8] Doses are then increased to effect (blood sugar levels being well controlled).[8] When nightly insulin is insufficient, twice daily insulin may achieve better control.[7] The long acting insulins glargine and detemir are equally safe and effective,[68] and do not appear much better than neutral protamine Hagedorn (NPH) insulin, but as they are significantly more expensive, they are not cost effective as of 2010.[69] In those who are pregnant insulin is generally the treatment of choice.[7]

Weight loss surgery in those who are obese is an effective measure to treat diabetes.[70] Many are able to maintain normal blood sugar levels with little or no medications following surgery[71] and long-term mortality is decreased.[72] There however is some short-term mortality risk of less than 1% from the surgery.[73] The body mass index cutoffs for when surgery is appropriate are not yet clear.[72] It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.[74]

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1522.5

22.530

3037.5

37.545

4552.5

52.560

6067.5

67.575

7582.5

82.5

Globally as of 2010 it was estimated that there were 285million people with type2 diabetes making up about 90% of diabetes cases.[4] This is equivalent to about 6% of the world's adult population.[75] Diabetes is common both in the developed and the developing world.[4] It remains uncommon, however, in the underdeveloped world.[3]

Women seem to be at a greater risk as do certain ethnic groups,[4][76] such as South Asians, Pacific Islanders, Latinos, and Native Americans.[7] This may be due to enhanced sensitivity to a Western lifestyle in certain ethnic groups.[77] Traditionally considered a disease of adults, type2 diabetes is increasingly diagnosed in children in parallel with rising obesity rates.[4] Type2 diabetes is now diagnosed as frequently as type1 diabetes in teenagers in the United States.[3]

Rates of diabetes in 1985 were estimated at 30million, increasing to 135million in 1995 and 217million in 2005.[5] This increase is believed to be primarily due to the global population aging, a decrease in exercise, and increasing rates of obesity.[5] The five countries with the greatest number of people with diabetes as of 2000 are India having 31.7million, China 20.8million, the United States 17.7million, Indonesia 8.4million, and Japan 6.8million.[78] It is recognized as a global epidemic by the World Health Organization.[79]

Diabetes is one of the first diseases described[80] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine."[81] The first described cases are believed to be of type1 diabetes.[81] Indian physicians around the same time identified the disease and classified it as madhumeha or honey urine noting that the urine would attract ants.[81] The term "diabetes" or "to pass through" was first used in 230BCE by the Greek Appollonius Of Memphis.[81] The disease was rare during the time of the Roman empire with Galen commenting that he had only seen two cases during his career.[81]

Type1 and type2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500AD with type1 associated with youth and type2 with being overweight.[81] The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus which is also associated with frequent urination.[81] Effective treatment was not developed until the early part of the 20th century when the Canadians Frederick Banting and Charles Best discovered insulin in 1921 and 1922.[81] This was followed by the development of the long acting NPH insulin in the 1940s.[81]

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Diabetes mellitus type 2 - Wikipedia, the free encyclopedia

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Last updated: Tuesday 16 June 2015

Last updated: Tue 16 Jun 2015

People can often have diabetes and be completely unaware. The main reason for this is that the symptoms, when seen on their own, seem harmless. However, the earlier diabetes is diagnosed the greater the chances are that serious complications, which can result from having diabetes, can be avoided.

The most common signs and symptoms of diabetes are:

We will examine each of these symptoms in more detail below.

Have you been going to the bathroom to urinate more often recently? Do you notice that you spend most of the day going to the toilet? When there is too much glucose (sugar) in your blood you will urinate more often. If your insulin is ineffective, or not there at all, your kidneys cannot filter the glucose back into the blood. The kidneys will take water from your blood in order to dilute the glucose - which in turn fills up your bladder.

If you are urinating more than usual, you will need to replace that lost liquid. You will be drinking more than usual. Have you been drinking more than usual lately?

As the insulin in your blood is not working properly, or is not there at all, and your cells are not getting their energy, your body may react by trying to find more energy - food. You will become hungry.

This might be the result of the above symptom (intense hunger).

This is more common among people with Diabetes Type 1. As your body is not making insulin it will seek out another energy source (the cells aren't getting glucose). Muscle tissue and fat will be broken down for energy. As Type 1 is of a more sudden onset and Type 2 is much more gradual, weight loss is more noticeable with Type 1.

If your insulin is not working properly, or is not there at all, glucose will not be entering your cells and providing them with energy. This will make you feel tired and listless.

Irritability can be due to your lack of energy.

This can be caused by tissue being pulled from your eye lenses. This affects your eyes' ability to focus. With proper treatment this can be treated. There are severe cases where blindness or prolonged vision problems can occur.

Do you find cuts and bruises take a much longer time than usual to heal? When there is more sugar (glucose) in your body, its ability to heal can be undermined.

When there is more sugar in your body, its ability to recover from infections is affected. Women with diabetes find it especially difficult to recover from bladder and vaginal infections.

A feeling of itchiness on your skin is sometimes a symptom of diabetes.

If your gums are tender, red and/or swollen this could be a sign of diabetes. Your teeth could become loose as the gums pull away from them.

As well as the previous gum symptoms, you may experience more frequent gum disease and/or gum infections.

If you are over 50 and experience frequent or constant sexual dysfunction (erectile dysfunction), it could be a symptom of diabetes.

If there is too much sugar in your body your nerves could become damaged, as could the tiny blood vessels that feed those nerves. You may experience tingling and/or numbness in your hands and feet.

Diabetes can often be detected by carrying out a urine test, which finds out whether excess glucose is present. This is normally backed up by a blood test, which measures blood glucose levels and can confirm if the cause of your symptoms is diabetes.

If you are worried that you may have some of the above symptoms, you are recommended to talk to your Doctor or a qualified health professional.

This diabetes information section was written by Christian Nordqvist. It was first published on 15 September 2010 and last updated on 19 May 2015.

Disclaimer: This informational section on Medical News Today is regularly reviewed and updated, and provided for general information purposes only. The materials contained within this guide do not constitute medical or pharmaceutical advice, which should be sought from qualified medical and pharmaceutical advisers.

Please note that although you may feel free to cite and quote this article, it may not be re-produced in full without the permission of Medical News Today. For further details, please view our full terms of use

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Diabetes Symptoms: Common Symptoms of Diabetes

INTRODUCTION

The Americans with Disabilities Act (ADA), which was amended by the ADA Amendments Act of 2008 ("Amendments Act" or "ADAAA"), is a federal law that prohibits discrimination against qualified individuals with disabilities. Individuals with disabilities include those who have impairments that substantially limit a major life activity, have a record (or history) of a substantially limiting impairment, or are regarded as having a disability.1

Title I of the ADA covers employment by private employers with 15 or more employees as well as state and local government employers. Section 501 of the Rehabilitation Act provides similar protections related to federal employment. In addition, most states have their own laws prohibiting employment discrimination on the basis of disability. Some of these state laws may apply to smaller employers and may provide protections in addition to those available under the ADA.2

The U.S. Equal Employment Opportunity Commission (EEOC) enforces the employment provisions of the ADA. This document, which is one of a series of question-and-answer documents addressing particular disabilities in the workplace,3 explains how the ADA applies to job applicants and employees who have or had diabetes. In particular, this document explains:

Diabetes is a group of diseases characterized by high blood glucose or sugar levels that result from defects in the body's ability to produce and/or use insulin.4 Insulin is a hormone that helps the glucose enter the body's cells to give them energy. With Type 1 diabetes, the body does not make insulin. With Type 2 diabetes, the more common type, the body does not make or use insulin well. Some women develop a type of diabetes called gestational diabetes during pregnancy when their bodies are not able to make and use all the insulin it needs, but may not have diabetes after giving birth. Without enough insulin, the glucose stays in the blood.5

Although diabetes cannot be cured, it can be managed. Some people are able to control their diabetes by eating a balanced diet, maintaining a healthy body weight, and exercising regularly. Many individuals, however, must take oral medication and/or administer insulin injections to manage their diabetes.6

With nearly two million new cases diagnosed each year, diabetes is becoming more prevalent in the United States and is the most common endocrine disease.7 Today, an estimated 18.8 million adults in the United States have diabetes.8

As a result of changes made by the ADAAA, individuals who have diabetes should easily be found to have a disability within the meaning of the first part of the ADA's definition of disability because they are substantially limited in the major life activity of endocrine function.9 Additionally, because the determination of whether an impairment is a disability is made without regard to the ameliorative effects of mitigating measures, diabetes is a disability even if insulin, medication, or diet controls a person's blood glucose levels. An individual with a past history of diabetes (for example, gestational diabetes) also has a disability within the meaning of the ADA.10 Finally, an individual is covered under the third ("regarded as") prong of the definition of disability if an employer takes a prohibited action (for example, refuses to hire or terminates the individual) because of diabetes or because the employer believes the individual has diabetes.11

Title I of the ADA limits an employer's ability to ask questions related to diabetes and other disabilities and to conduct medical examinations at three stages: pre-offer, post-offer, and during employment.

Before an Offer of Employment Is Made

1. May an employer ask a job applicant whether she has or had diabetes or about her treatment related to diabetes before making a job offer?

No. An employer may not ask questions about an applicant's medical condition12 or require an applicant to have a medical examination before it makes a conditional job offer. This means that an employer cannot legally ask an applicant questions such as:

Of course, an employer may ask questions pertaining to the qualifications for, or performance of, the job, such as:

2. Does the ADA require an applicant to disclose that she has or had diabetes or some other disability before accepting a job offer?

No. The ADA does not require applicants to voluntarily disclose that they have or had diabetes or another disability unless they will need a reasonable accommodation for the application process (for example, a break to eat a snack or monitor their glucose levels). Some individuals with diabetes, however, choose to disclose their condition because they want their co-workers or supervisors to know what to do if they faint or experience other symptoms of hypoglycemia (low blood sugar), such as weakness, shakiness, or confusion. 13

Sometimes, the decision to disclose depends on whether an individual will need a reasonable accommodation to perform the job (for example, breaks to take medication or a place to rest until blood sugar levels become normal). A person with diabetes, however, may request an accommodation after becoming an employee even if she did not do so when applying for the job or after receiving the job offer.

3. May an employer ask any follow-up questions if an applicant voluntarily reveals that she has or had diabetes?

No. An employer generally may not ask an applicant who has voluntarily disclosed that she has diabetes any questions about her diabetes, its treatment, or its prognosis. However, if an applicant voluntarily discloses that she has diabetes and the employer reasonably believes that she will require an accommodation to perform the job because of her diabetes or treatment, the employer may ask whether the applicant will need an accommodation and what type. The employer must keep any information an applicant discloses about her medical condition confidential. (See "Keeping Medical Information Confidential.")

After an Offer of Employment Is Made

After making a job offer, an employer may ask questions about the applicant's health (including questions about the applicant's disability) and may require a medical examination, as long as all applicants for the same type of job are treated equally (that is, all applicants are asked the same questions and are required to take the same examination). After an employer has obtained basic medical information from all individuals who have received job offers, it may ask specific individuals for more medical information if it is medically related to the previously obtained medical information. For example, if an employer asks all applicants post-offer about their general physical and mental health, it can ask individuals who disclose a particular illness, disease, or impairment for more medical information or require them to have a medical examination related to the condition disclosed.

4. What may an employer do when it learns that an applicant has or had diabetes after she has been offered a job but before she starts working?

When an applicant discloses after receiving a conditional job offer that she has diabetes, an employer may ask the applicant additional questions such as how long she has had diabetes; whether she uses insulin or oral medication; whether and how often she experiences hypoglycemic episodes; and/or whether she will need assistance if her blood sugar level drops while at work. The employer also may send the applicant for a follow-up medical examination or ask her to submit documentation from her doctor answering questions specifically designed to assess her ability to perform the job's functions safely. Permissible follow-up questions at this stage differ from those at the pre-offer stage when an employer only may ask an applicant who voluntarily discloses a disability whether she needs an accommodation to perform the job and what type.

An employer may not withdraw an offer from an applicant with diabetes if the applicant is able to perform the essential functions of the job, with or without reasonable accommodation, without posing a direct threat (that is, a significant risk of substantial harm) to the health or safety of himself or others that cannot be eliminated or reduced through reasonable accommodation. ("Reasonable accommodation" is discussed at Questions 10 through 15. "Direct threat" is discussed at Questions 6 and 16 through 18.)

The ADA strictly limits the circumstances under which an employer may ask questions about an employee's medical condition or require the employee to have a medical examination. Once an employee is on the job, her actual performance is the best measure of ability to do the job.

5. When may an employer ask an employee whether diabetes, or some other medical condition, may be causing her performance problems?

Generally, an employer may ask disability-related questions or require an employee to have a medical examination when it knows about a particular employee's medical condition, has observed performance problems, and reasonably believes that the problems are related to a medical condition. At other times, an employer may ask for medical information when it has observed symptoms, such as extreme fatigue or irritability, or has received reliable information from someone else (for example, a family member or co-worker) indicating that the employee may have a medical condition that is causing performance problems. Often, however, poor job performance is unrelated to a medical condition and generally should be handled in accordance with an employer's existing policies concerning performance.15

Example 4: A normally reliable secretary with diabetes has been coming to work late and missing deadlines. The supervisor observed these changes soon after the secretary started going to law school in the evenings. The supervisor can ask the secretary why his performance has declined but may not ask him about his diabetes unless there is objective evidence that his poor performance is related to his medical condition.

6. May an employer require an employee on leave because of diabetes to provide documentation or have a medical examination before allowing her to return to work?

Yes. If the employer has a reasonable belief that the employee may be unable to perform her job or may pose a direct threat to herself or others, the employer may ask for medical information. However, the employer may obtain only the information needed to make an assessment of the employee's present ability to perform her job and to do so safely.

7. Are there any other instances when an employer may ask an employee with diabetes about his condition?

Yes. An employer also may ask an employee about diabetes when it has a reasonable belief that the employee will be unable to safely perform the essential functions of his job because of diabetes. In addition, an employer may ask an employee about his diabetes to the extent the information is necessary:

With limited exceptions, an employer must keep confidential any medical information it learns about an applicant or employee. Under the following circumstances, however, an employer may disclose that an employee has diabetes:

8. May an employer tell employees who ask why their co-worker is allowed to do something that generally is not permitted (such as eat at his desk or take more breaks) that she is receiving a reasonable accommodation?

No. Telling co-workers that an employee is receiving a reasonable accommodation amounts to a disclosure that the employee has a disability. Rather than disclosing that the employee is receiving a reasonable accommodation, the employer should focus on the importance of maintaining the privacy of all employees and emphasize that its policy is to refrain from discussing the work situation of any employee with co-workers. Employers may be able to avoid many of these kinds of questions by training all employees on the requirements of equal employment opportunity laws, including the ADA.

Additionally, an employer will benefit from providing information about reasonable accommodations to all of its employees. This can be done in a number of ways, such as through written reasonable accommodation procedures, employee handbooks, staff meetings, and periodic training. This kind of proactive approach may lead to fewer questions from employees who misperceive co-worker accommodations as "special treatment."

9. If an employee experiences an insulin reaction at work, may an employer explain to other employees or managers that the employee has diabetes?

No. Although the employee's co-workers and others in the workplace who witness the reaction naturally may be concerned, an employer may not reveal that the employee has diabetes. Rather, the employer should assure everyone present that the situation is under control. An employee, however, may voluntarily choose to tell her co-workers that she has diabetes and provide them with helpful information, such as how to recognize when her blood sugar may be low, what to do if she faints or seems shaky or confused (for example, offer a piece of candy or gum), or where to find her glucose monitoring kit. However, even when an employee voluntarily discloses that she has diabetes, the employer must keep this information confidential consistent with the ADA. An employer also may not explain to other employees why an employee with diabetes has been absent from work if the absence is related to her diabetes or another disability.

The ADA requires employers to provide adjustments or modifications -- called reasonable accommodations -- to enable applicants and employees with disabilities to enjoy equal employment opportunities unless doing so would be an undue hardship (that is, a significant difficulty or expense). Accommodations vary depending on the needs of the individual with a disability. Not all employees with diabetes will need an accommodation or require the same accommodations, and most of the accommodations a person with diabetes might need will involve little or no cost. An employer must provide a reasonable accommodation that is needed because of the diabetes itself, the effects of medication, or both. For example, an employer may have to accommodate an employee who is unable to work while learning to manage her diabetes or adjusting to medication. An employer, however, has no obligation to monitor an employee to make sure that she is regularly checking her blood sugar levels, eating, or taking medication as prescribed.

10. What other types of reasonable accommodations may employees with diabetes need?

Some employees may need one or more of the following accommodations:

Although these are some examples of the types of accommodations commonly requested by employees with diabetes, other employees may need different changes or adjustments. Employers should ask the particular employee requesting an accommodation what he needs that will help him do his job. There also are extensive public and private resources to help employers identify reasonable accommodations. For example, the website for the Job Accommodation Network (JAN)(http://askjan.org/media/Diabetes.html) provides information about many types of accommodations for employees with diabetes.

11. How does an employee with diabetes request a reasonable accommodation?

There are no "magic words" that a person has to use when requesting a reasonable accommodation. A person simply has to tell the employer that she needs an adjustment or change at work because of her diabetes. A request for a reasonable accommodation also can come from a family member, friend, health professional, or other representative on behalf of a person with diabetes.

12. May an employer request documentation when an employee who has diabetes requests a reasonable accommodation?

Yes. An employer may request reasonable documentation where a disability or the need for reasonable accommodation is not known or obvious. An employer, however, is entitled only to documentation sufficient to establish that the employee has diabetes and to explain why an accommodation is needed. A request for an employee's entire medical record, for example, would be inappropriate as it likely would include information about conditions other than the employee's diabetes.20

13. Does an employer have to grant every request for a reasonable accommodation?

No. An employer does not have to provide an accommodation if doing so will be an undue hardship. Undue hardship means that providing the reasonable accommodation will result in significant difficulty or expense. An employer also does not have to eliminate an essential function of a job as a reasonable accommodation, tolerate performance that does not meet its standards, or excuse violations of conduct rules that are job-related and consistent with business necessity and that the employer applies consistently to all employees (such as rules prohibiting violence, threatening behavior, theft, or destruction of property).

If more than one accommodation will be effective, the employee's preference should be given primary consideration, although the employer is not required to provide the employee's first choice of reasonable accommodation. If a requested accommodation is too difficult or expensive, an employer may choose to provide an easier or less costly accommodation as long as it is effective in meeting the employee's needs.

14. May an employer be required to provide more than one accommodation for the same employee with diabetes?

Yes. The duty to provide a reasonable accommodation is an ongoing one. Although some employees with diabetes may require only one reasonable accommodation, others may need more than one. For example, an employee with diabetes may require leave to attend a class on how to administer insulin injections and later may request a part-time or modified schedule to better control his glucose levels. An employer must consider each request for a reasonable accommodation and determine whether it would be effective and whether providing it would pose an undue hardship.

15. May an employer automatically deny a request for leave from someone with diabetes because the employee cannot specify an exact date of return?

No. Granting leave to an employee who is unable to provide a fixed date of return may be a reasonable accommodation. Although diabetes can be successfully treated, some individuals experience serious complications that may be unpredictable and do not permit exact timetables. An employee requesting leave because of diabetes or resulting complications (for example, a foot or toe amputation), therefore, may be able to provide only an approximate date of return (e.g., "in six to eight weeks," "in about three months"). In such situations, or in situations in which a return date must be postponed because of unforeseen medical developments, employees should stay in regular communication with their employers to inform them of their progress and discuss the need for continued leave beyond what originally was granted. The employer also has the right to require that the employee provide periodic updates on his condition and possible date of return. After receiving these updates, the employer may reevaluate whether continued leave constitutes an undue hardship.

When it comes to safety concerns, an employer should be careful not to act on the basis of myths, fears, or stereotypes about diabetes. Instead, the employer should evaluate each individual on her skills, knowledge, experience and how having diabetes affects her.

16. When may an employer refuse to hire, terminate, or temporarily restrict the duties of a person who has diabetes because of safety concerns?

An employer only may exclude an individual with diabetes from a job for safety reasons when the individual poses a direct threat. A "direct threat" is a significant risk of substantial harm to the individual or others that cannot be eliminated or reduced through reasonable accommodation.21 This determination must be based on objective, factual evidence, including the best recent medical evidence and advances in the treatment of diabetes.

In making a direct threat assessment, the employer must evaluate the individual's present ability to safely perform the job. The employer also must consider:

The harm must be serious and likely to occur, not remote or speculative. Finally, the employer must determine whether any reasonable accommodation (for example, temporarily limiting an employee's duties, temporarily reassigning an employee, or placing an employee on leave) would reduce or eliminate the risk.23

Example 13: When an actor forgets his lines and stumbles during several recent play rehearsals, he explains that the fluctuating rehearsal times are interfering with when he eats and takes his insulin. Because there is no reason to believe that the actor poses a direct threat, the director cannot terminate the actor or replace him with an understudy; rather, the director should consider whether rehearsals can be held at a set time and/or whether the actor can take a break when needed to eat, monitor his glucose, or administer his insulin

17. May an employer require an employee who has had an insulin reaction at work to submit periodic notes from his doctor indicating that his diabetes is under control?

Yes, but only if the employer has a reasonable belief that the employee will pose a direct threat if he does not regularly see his doctor. In determining whether to require periodic documentation, the employer should consider the safety risks associated with the position the employee holds, the consequences of the employee's inability or impaired ability to perform his job, how long the employee has had diabetes, and how many insulin reactions the employee has had on the job.

Example 15:The owner of a daycare center knows that one of her teachers has diabetes and that she once had an insulin reaction at work when she skipped lunch. When the owner sees the teacher eat a piece of cake at a child's birthday party, she becomes concerned that the teacher may have an insulin reaction. Although many people believe that individuals with diabetes should never eat sugar or sweets, this is a myth. The owner, therefore, cannot require the teacher to submit periodic notes from her doctor indicating that her diabetes is under control because she does not have a reasonable belief, based on objective evidence, that the teacher will pose a direct threat to the safety of herself or others.

18. What should an employer do when another federal law prohibits it from hiring anyone who uses insulin?

If a federal law prohibits an employer from hiring a person who uses insulin, the employer is not be liable under the ADA. The employer should be certain, however, that compliance with the law actually is required, not voluntary. The employer also should be sure that the law does not contain any exceptions or waivers. For example, the Department of Transportation's Federal Motor Carrier Safety Administration (FMCSA) issues exemptions to certain individuals with diabetes who wish to drive commercial motor vehicles (CMVs).24

The ADA prohibits harassment, or offensive conduct, based on disability just as other federal laws prohibit harassment based on race, sex, color, national origin, religion, age, and genetic information. Offensive conduct may include, but is not limited to, offensive jokes, slurs, epithets or name calling, physical assaults or threats, intimidation, ridicule or mockery, insults or put-downs, offensive objects or pictures, and interference with work performance. Although the law does not prohibit simple teasing, offhand comments, or isolated incidents that are not very serious, harassment is illegal when it is so frequent or severe that it creates a hostile or offensive work environment or when it results in an adverse employment decision (such as the victim being fired or demoted).

19. What should employers do to prevent and correct harassment?

Employers should make clear that they will not tolerate harassment based on disability or on any other basis. This can be done in a number of ways, such as through a written policy, employee handbooks, staff meetings, and periodic training. The employer should emphasize that harassment is prohibited and that employees should promptly report such conduct to a manager. Finally, the employer should immediately conduct a thorough investigation of any report of harassment and take swift and appropriate corrective action. For more information on the standards governing harassment under all of the EEO laws, see http://www.eeoc.gov/policy/docs/harassment.html.

The ADA prohibits retaliation by an employer against someone who opposes discriminatory employment practices, files a charge of employment discrimination, or testifies or participates in any way in an investigation, proceeding, or litigation related to a charge of employment discrimination. It is also unlawful for an employer to retaliate against someone for requesting a reasonable accommodation. Persons who believe that they have experienced retaliation may file a charge of retaliation as described below.

Any person who believes that his or her employment rights have been violated on the basis of disability and wants to make a claim against an employer must file a charge of discrimination with the EEOC. A third party may also file a charge on behalf of another person who believes he or she experienced discrimination. For example, a family member, social worker, or other representative can file a charge on behalf of someone who is incapacitated because of diabetes. The charge must be filed by mail or in person with the local EEOC office within 180 days from the date of the alleged violation. The 180-day filing deadline is extended to 300 days if a state or local anti-discrimination agency has the authority to grant or seek relief as to the challenged unlawful employment practice.

The EEOC will send the parties a copy of the charge and may ask for responses and supporting information. Before formal investigation, the EEOC may select the charge for EEOC's mediation program. Both parties have to agree to mediation, which may prevent a time consuming investigation of the charge. Participation in mediation is free, voluntary, and confidential.

If mediation is unsuccessful, the EEOC investigates the charge to determine if there is "reasonable cause" to believe discrimination has occurred. If reasonable cause is found, the EEOC will then try to resolve the charge with the employer. In some cases, where the charge cannot be resolved, the EEOC will file a court action. If the EEOC finds no discrimination, or if an attempt to resolve the charge fails and the EEOC decides not to file suit, it will issue a notice of a "right to sue," which gives the charging party 90 days to file a court action. A charging party can also request a notice of a "right to sue" from the EEOC 180 days after the charge was first filed with the Commission, and may then bring suit within 90 days after receiving the notice. For a detailed description of the process, you can visit our website at http://www.eeoc.gov/employees/howtofile.cfm.

If you are a federal employee or job applicant and you believe that a federal agency has discriminated against you, you have a right to file a complaint. Each agency is required to post information about how to contact the agency's EEO Office. You can contact an EEO Counselor by calling the office responsible for the agency's EEO complaints program. Generally, you must contact the EEO Counselor within 45 days from the day the discrimination occurred. In most cases the EEO Counselor will give you the choice of participating either in EEO counseling or in an alternative dispute resolution (ADR) program, such as a mediation program.

If you do not settle the dispute during counseling or through ADR, you can file a formal discrimination complaint against the agency with the agency's EEO Office. You must file within 15 days from the day you receive notice from your EEO Counselor about how to file.

Once you have filed a formal complaint, the agency will review the complaint and decide whether or not the case should be dismissed for a procedural reason (for example, your claim was filed too late). If the agency doesn't dismiss the complaint, it will conduct an investigation. The agency has 180 days from the day you filed your complaint to finish the investigation. When the investigation is finished, the agency will issue a notice giving you two choices: either request a hearing before an EEOC Administrative Judge or ask the agency to issue a decision as to whether the discrimination occurred. For a detailed description of the process, you can visit our website at http://www.eeoc.gov/federal/fed_employees/complaint_overview.cfm.

Footnotes

1 See 42 U.S.C. 12102(2); 29 C.F.R. 1630.2(g).

2 For example, disability laws in California, Pennsylvania, New Jersey, and New York apply to employers with fewer than 15 employees.

3 See "The Question and Answer Series" under "Available Resources" on EEOC's website at http://www.eeoc.gov/laws/types/disability.cfm.

4 See Diabetes Basics, http://www.diabetes.org/diabetes-basics (last visited January 10, 2013); see also http://www.diabetes.org/diabetes-basics/gestational/

5 Id.; see also information on diabetes from the National Institutes of Health, http://www.nlm.nih.gov/medlineplus/diabetes.html.

6 Diabetes Basics, supra note 4.

7 According to the Centers for Disease Control and Prevention (CDC), about 1.9 million people aged 20 or older were newly diagnosed with diabetes in the United States in 2010. See National Diabetes Fact Sheet (2011), http://www.cdc.gov/diabetes/pubs/factsheet11.htm (last visited January 10, 2013);see also Endocrine Diseases, http://www.nim.nih.gov/medlineplus/endocrinediseases.html#cat1.

8 See 2011 National Diabetes Fact Sheet (released January 26, 2011), http://www.diabetes.org/diabetes-basics/diabetes-statistics (last visited January 13, 2013).

9 See 29 C.F.R. 1630.2(j)(3)(iii).

10 Id. at 1630.2(k).

11 Id. at 1630.2(l).

12 Federal contractors are required under 41 C.F.R. 60-741.42, a regulation issued by the Office of Federal Contract Compliance Programs (OFCCP), to invite applicants to voluntarily self-identify as persons with disabilities for affirmative action purposes. The ADA prohibition on asking applicants about medical conditions at the pre-offer stage does not prevent federal contractors from complying with the OFCCP's regulation. See Letter from Peggy R. Mastroianni, EEOC Legal Counsel, to Patricia A. Shiu, Director of OFCCP, http://www.dol.gov/ofccp/regs/compliance/section503.htm#bottom.

13 Insulin and some oral medications can sometimes cause a person's blood sugar levels to drop too low. A person experiencing hypoglycemia (low blood sugar) may feel weak, shaky, confused, or faint. Most people with diabetes, however, recognize these symptoms and will immediately drink or eat something sweet. Many individuals with diabetes also carry a blood glucose monitoring kit with them at all times and test their blood sugar levels as soon as they feel minor symptoms such as shaking or sweating. Often, a person's blood sugar returns to normal within 15 minutes of eating or drinking something sweet. See generally information from the American Association of Diabetes, http://www.diabetes.org.

14 Asking an applicant or employee about family medical history also violates Title II of the Genetic Information Nondiscrimination Act (GINA), 42 U.S.C. 2000ff et seq., which prohibits employers from requesting, requiring, or purchasing genetic information (including family medical history) about applicants or employees. 29 C.F.R. 1635.8(a).

15 An employer also may ask an employee about his diabetes or send the employee for a medical examination when it reasonably believes the employee may pose a direct threat because of his diabetes. See "Concerns About Safety."

16 An employer also may ask an employee for periodic updates on his condition if the employee has taken leave and has not provided an exact or fairly specific date of return or has requested leave in addition to that already granted. See also Q&A 15. Of course, an employer may call employees on extended leave to check on their progress or to express concern for their health without violating the ADA.

17 The ADA allows employers to conduct voluntary medical examinations and activities, including obtaining voluntary medical histories, which are part of an employee wellness program (such as a smoking cessation or diabetes detection screening and management program), as long as any medical records (including, for example, the results any diagnostic tests) acquired as part of the program are kept confidential. See Q&A 22 in EEOC Enforcement Guidance on Disability-Related Inquiries and Medical Examinations of Employees Under the ADA, http://www.eeoc.gov/policy/docs/guidance-inquiries.html

18 An employee with diabetes who needs continuing or intermittent leave, or a part-time or modified schedule, as a reasonable accommodation also may be entitled to leave under the Family and Medical Leave Act (FMLA). For a discussion of how employers should treat situations in which an employee may be covered both by the FMLA and the ADA, see Questions 21 and 23 in the EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act (rev. Oct. 17, 2002) at http://www.eeoc.gov/policy/docs/accommodation.html.

19 Diabetic neuropathy is a common complication of diabetes in which nerves are damaged as a result of high blood sugar levels (hyperglycemia). See National Center for Biotechnology Information, U.S. National Library of Medicine, http://www.ncbi.nlm.nih.gov.

20 Requests for documentation to support a request for accommodation may violate Title II of GINA where they are likely to result in the acquisition of genetic information, including family medical history. 29 C.F.R. 1635.8(a). For this reason employers may want to include a warning in the request for documentation that the employee or the employee's doctor should not provide genetic information. Id. at 1635.8(b)(1)(i)(B).

21 See 29 C.F.R. 1630.2(r).

22 Id.

23 Id.

24 Under FMCSA's Diabetes Exemption Program, an individual who intends to operate a CMV in interstate commerce may apply for an exemption from the diabetes standard if he or she meets all medical standards and guidelines, other than diabetes, in accordance with 49 CFR 391.41 (b) (1-13).

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Inattentional blindness, also known as perceptual blindness, is a psychological lack of attention and is not associated with any vision defects or deficits. It may be further defined as the event in which an individual fails to recognize an unexpected stimulus that is in plain sight. The term was coined by Arien Mack and Irvin Rock in 1992 and was used as the title of their book of the same name, published by MIT press in 1998.[1] Here, they describe the discovery of inattentional blindness and include a collection of procedures used describing the phenomenon.[2] Research[citation needed] on inattentional blindness suggests that the phenomenon can occur in any individual, independent of cognitive deficits. When it simply becomes impossible for one to attend to all the stimuli in a given situation, a temporary blindness effect can take place as a result; that is, individuals fail to see objects or stimuli that are unexpected and quite often salient.[citation needed]

Inattentional blindness also has an effect on peoples perception. There have been numerous experiments performed that demonstrate this phenomenon.[3]

The following criteria are required to classify an event as an inattentional blindness episode: 1) the observer must fail to notice a visual object or event, 2) the object or event must be fully visible, 3) observers must be able to readily identify the object if they are consciously perceiving it,[2] and 4) the event must be unexpected and the failure to see the object or event must be due to the engagement of attention on other aspects of the visual scene and not due to aspects the visual stimulus itself.[2] Individuals who experience inattentional blindness are usually unaware of this effect, which can play a subsequent role on behavior.

Inattentional blindness is related to but distinct from other failures of visual awareness such as change blindness, repetition blindness, visual masking, and attentional blink. The key aspect of inattentional blindess which makes it distinct from other failures in awareness rests on the fact that the undetected stimulus is unexpected.[4] It is the unexpected nature of said stimulus that differentiates inattentional blindness from failures of awareness such as attentional failures like the aforementioned attentional blink. It is critical to acknowledge that occurrences of inattentional blindness are attributed to the failure to consciously attend to an item in the visual field as opposed the absence of cognitive processing.

Findings such as inattentional blindness - the failure to notice a fully visible but unexpected object because attention was engaged on another task, event, or object - has changed views on how the brain stores and integrates visual information, and has led to further questioning and investigation of the brain and importantly of cognitive processes.

Cognitive capture or, cognitive tunneling, is an inattentional blindness phenomenon in which the observer is too focused on instrumentation, task at hand, internal thought, etc. and not on the present environment. For example, while driving, a driver focused on the speedometer and not on the road is suffering from cognitive capture.[5]

One of the most foremost conflicts among researchers of inattentional blindness surrounds the processing of unattended stimuli. More specifically, there is disagreement in the literature about exactly how much processing of a visual scene is completed before selection dictates which stimuli will be consciously perceived, and which will not be (i.e. inattentional blindness). There exists two basic schools of thought on the issue - those who believe selection occurs early in the perceptual process, and those who believe it occurs only after significant processing.[6] Early selection theorists propose that perception of stimuli is a limited process requiring selection to proceed. This suggests that the decision to attend to specific stimuli occurs early in processing, soon after the rudimentary study of physical features; only those selected stimuli are then fully processed. On the other hand, proponents of late selection theories argue that perception is an unlimited operation, and all stimuli in a visual scene are processed simultaneously. In this case, selection of relevant information is done after full processing of all stimuli.[7]

While early research on the topic was heavily focused on early selection, research since the late 1970s has been shifted mainly to the late selection theories. This change resulted primarily from a shift in paradigms used to study inattentional blindness which revealed new aspects of the phenomenon.[8] Today, late selection theories are generally accepted, and continue to be the focus of the majority of research concerning inattentional blindness.

A significant body of research has been gathered in support of late selection in the perception of visual stimuli.

One of the popular ways of investigating late selection is to assess the priming properties (i.e. influencing subsequent acts[9]) of unattended stimuli. Often used to demonstrate such effects is the stem completion task. While there exist a few variations, these studies generally consist of showing participants the first few letters of words, and asking them to complete the string of letters to form an English word.[9] It has been demonstrated that observers are significantly more likely to complete word fragments with the unattended stimuli presented in a trial than with another similar word.[1] This effect holds when stimuli are not words, but instead objects. When photos of objects are shown too quickly for participants to identify, subsequent presentation of those items lead to significantly faster identification in comparison to novel objects.[9]

A notable study by Mack and Rock has also revealed that showing a word stimulus differing from the participant's name by one letter did not generally call conscious attention. By simply changing a character, transforming the presented word into the observer's first name, the now highly meaningful stimulus is significantly more likely to be attended to. This suggests that the stimuli are being extensively processed, at least enough to analyze their meaning. These results point to the fact that attentional selection may be determined late in processing.[1]

The evidence outlined above suggests that even when stimuli are not processed to the level of conscious attention, they are nonetheless perceptually and cognitively processed, and can indeed exert effects on subsequent behavior.[10]

While the evidence supporting late selection hypotheses is significant and has been consistently reproduced, there also exists a body of research suggesting that unattended stimuli in fact may not receive significant processing.

For example, in an functional magnetic resonance imaging (fMRI) study by Rees and colleagues, brain activity was recorded while participants completed a perceptual task. Here they examined the neural processing of meaningful (words) and meaningless (consonant string) stimuli both when attended to, and when these same items were unattended. While no difference in activation patterns were found between the groups when the stimuli were unattended, differences in neural processing were observed for meaningful versus meaningless stimuli to which participants overtly attended. This pattern of results suggests that ignored stimuli are not processed to the level of meaning, i.e. less extensively than attended stimuli.[11] Participants do not seem to be detecting meaning in stimuli to which they are not consciously attending.

This particular hypothesis bridges the gap between the early and late selection theories. Authors integrate the viewpoint of early selection stating that perception is a limited process (i.e. cognitive resources are limited), and that of the late selection theories assuming perception as an automatic process.[7] This view proposes that the level of processing which occurs for any one stimulus is dependent on the current perceptual load. That is, if the current task is attentionally demanding and its processing exhausts all the available resources, little remains available to process other non-target stimuli in the visual field. Alternatively, if processing requires a small amount of attentional resources, perceptual load is low and attention is inescapably directed to the non-target stimuli.[6]

The effects of perceptual load on the occurrence of inattentional blindness is demonstrated in a study by Fougnie and Marois. Here, participants were asked to complete a memory task involving either the simple maintenance of verbal stimuli, or the rearrangement of this material, a more cognitively demanding exercise. While subjects were completing the assigned task, an unexpected visual stimulus was presented. Results revealed that unexpected stimuli were more likely to be missed during manipulation of information than in the more simple rehearsal task.[12]

In a similar type of study, fMRI recordings were done while subjects took part in either low-demand or high-demand subtraction tasks. While performing these exercises, novel visual distractors were presented. When task demands were low and used a smaller portion of the finite resources, distractors captured attention and sparked visual analysis as shown by brain activation in the primary visual cortex. These results, however, did not hold when perceptual load was high; in this condition, distractors were significantly less often attended to and processed.[6]

Thus, higher perceptual load, and therefore more significant use of attentional resources, appears to increase the likelihood of inattentional blindness episodes.

The theory of inattentional amnesia provides an alternative in the explanation of inattentional blindness in suggesting that the phenomenon does not stem from failures in capture of attention or in actual perception of stimuli, but instead from a failure in memory. The unnoticed stimuli in a visual scene are attended to and consciously perceived, but are rapidly forgotten rendering them impossible to report.[13] In essence, inattentional amnesia refers to the failure in creating a lasting explicit memory: by the time a subject is asked to recall seeing an item, their memory for the stimulus has vanished.[14]

While it is difficult to tease apart a failure in perception from one in memory, some research has attempted to shed light on the issue. In a now-classic study of inattentional blindness, a woman carrying an umbrella through a scene goes unnoticed. Despite stopping the video while she is walking through and immediately asking participants to identify which of two people they have seen - leaving as little delay as possible between presentation and report - observers very often fail to correctly identify the woman with the umbrella. No differences in performance were identified whether the video was stopped immediately after the unexpected event or moments later. These findings would seem to oppose the idea of inattentional amnesia, however advocates of the theory could always contend that the memory test simply came too late and that the memory had already been lost.[15]

The very phenomenon of inattentional blindness is defined by a lack of expectation for the unattended stimulus. Some researchers believe that it is not inattention that produces blindness, but in fact the aforementioned lack of expectation for the stimuli.[10] Proponents of this theory often state that classic methods for testing inattentional blindness are not manipulating attention per se, but instead the expectation for the presentation of a visual item.[16]

Studies investigating the effect of expectation on episodes of inattentional blindness have shown that once observers are made aware of the importance of the to be presented stimuli, for example stating that one will later be tested on it, the phenomenon essentially disappears.[1] While admitting to possible ambiguities in methodology, Mack, one of the foremost researchers in the field, holds strongly that inattentional blindness stems predominantly from a failure of attentional capture. She points out that if expectation does not mediate instances of very closely linked phenomena such as attentional blink and change blindness (whereby participants have difficulty identifying the changing object even when they are explicitly told to look for it), it is unlikely that inattentional blindness can be explained solely by a lack of expectation for stimulus presentation.[10]

The perceptual cycle framework has been used as another theoretical basis for inattentional blindness. The perceptual cycle framework describes attention capture and awareness capture as occurring at two different stages of processing. Attention capture occurs when there is a shift in attention due to the salience of a stimuli, and awareness capture refers to the conscious acknowledgement of stimuli. Attentional sets are important because it is composed of characteristics of stimuli an individual is processing. Inattentional blindness occurs when there is an interaction between an individual's attentional set and the salience of the unexpected stimulus. Recognizing the unexpected stimulus can occur when the characteristics of the unexpected stimulus resembles the characteristics of the perceived stimuli. The attentional set theory of inattentional blindness has implications for false memories and eyewitness testimony. The perceptual cycle framework offers four major implications about inattentional blindness 1) environmental cues aid in the detection of stimuli by providing orienting cues but is not enough to produce awareness, 2) perception requires effortful sustained attention, interpretation, and reinterpretation, 3) implicit memory may precede conscious perception, and 4) visual stimuli that is not expected, explored, or interpreted may not be perceived.[17]

Other bases for attentional blindness include top down and bottom up processing.

To test for inattentional blindness, researchers ask participants to complete a primary task while an unexpected stimulus is presented. Afterwards, researchers ask participants if they saw anything unusual during the primary task. Arien Mack and Irvin Rock describe a series of experiments that demonstrated inattentional blindness in their 1998 book, Inattentional Blindness.

The best-known study demonstrating inattentional blindness is the Invisible Gorilla Test, conducted by Daniel Simons of the University of Illinois at Urbana-Champaign and Christopher Chabris of Harvard University. This study, a revised version of earlier studies conducted by Ulric Neisser, Neisser and Becklen in 1975, asked subjects to watch a short video of two groups of people (wearing black and white t-shirts) pass a basketball around. The subjects are told to either count the number of passes made by one of the teams or to keep count of bounce passes vs. aerial passes. In different versions of the video a woman walks through the scene carrying an umbrella (as discussed above), or wearing a full gorilla suit. After watching the video the subjects are asked if they noticed anything out of the ordinary take place. In most groups, 50% of the subjects did not report seeing the gorilla (or the woman with the umbrella). The failure to perceive the anomalies is attributed to the failure to attend to it while engaged in the difficult task of counting the number of passes of the ball. These results indicate that the relationship between what is in one's visual field and perception is based much more on attention than was previously thought.[18]

Although it was found that 50% of the test subjects demonstrated change blindness to the introduction of the gorilla or the umbrella, it is difficult to find published information on what percentage of study participants were able to accurately count the passes.[19]

The basic Simons and Chabris study was re-used on British television as a public safety advert designed to point out the potential dangers to cyclists caused by inattentional blindness in motorists. In the advert the gorilla is replaced by a moon-walking bear.[20]

In 1995, Officer Kenny Conley was chasing a shooting suspect. An undercover officer was in the same vicinity and was mistakenly taken down by other officers while Conley ran by and failed to notice. A jury later convicted Officer Conley of perjury and obstruction of justice, believing he had seen the fight and lied about it to protect fellow officers, yet he stood by his word that he had, in fact, not seen it.[21]

Christopher Chabris, Adam Weinberger, Matthew Fontaine and Daniel J. Simons took it upon themselves to see if this scenario was possible. They designed an experiment in which participants were asked to run about 30 feet behind Officer Conley himself, and count how many times he touched his head. A fight was staged to appear about 8 meters off the path, and was visible for approximately 15 seconds. The procedure in its entirety lasted about 2 minutes and 45 seconds, and participants were then asked to report the number of times they had seen Officer Conley touch his head with either hand (medium load), both hands (high load), or were not instructed to count at all (low load). After the run, participants were asked 3 questions: 1) If they had noticed the fight; 2) if they had noticed a juggler, and 3) if they had noticed someone dribbling a basketball. Questions 2) and 3) were control questions, and no one falsely reported these as true.

Participants were significantly more likely to notice the fight when the experiment was done during the day as opposed to in the dark. Additionally, sightings of the fight were most likely to be reported in the low load condition (72%) than in either the medium load (56%), or high load conditions (42%).[22] These results exemplify a real world occurrence of inattentional blindness, and provide evidence that officer Conley could indeed have missed the fight because his attention was focused elsewhere. Moreover, these results add to the body of knowledge suggesting that as perceptual load increases, less resources remain to process items not explicitly focused on, and in turn episodes of inattentional blindness become more frequent.

Another experiment was conducted by Steven Most, along with Daniel Simons, Christopher Chabris and Brian Scholl. Instead of a basketball game, they used stimuli presented by computer displays. In this experiment objects moved randomly on a computer screen. Participants were instructed to attend to the black objects and ignore the white, or vice versa. After several trials, a red cross unexpectedly appeared and traveled across the display, remaining on the computer screen for five seconds. The results of the experiment showed that even though the cross was distinctive from the black and white objects both in color and shape, about a third of participants missed it. They had found that people may be attentionally tuned to certain perceptual dimensions, such as brightness or shape. Inattentional blindness is most likely to occur if the unexpected stimuli presented resembles the environment.[23]

One interesting experiment displayed how cell phones contributed to inattentional blindness in basic tasks such as walking. The stimuli for this experiment was a brightly colored clown on a unicycle. The individuals participating in this experiment were divided into four sections. They were either talking on the phone, listening to an mp3 player, walking by themselves or walking in pairs. The study showed that individuals engaged in cell phone conversations were least likely to notice the clown. This experiment was designed by Ira E. Hyman, S. Matthew Boss, Breanne M. Wise, Kira E. Mckenzie and Jenna M. Caggiano at Western Washington University.[24]

Daniel Memmert conducted an experiment which suggests that an individual can look directly at an object and still not perceive it. This experiment was based on the invisible gorilla experiment. The participants were children with an average age of 7.7 years. Participants watched a short video of a six player basketball game (three with white shirts, three with black shirts). The participants were instructed to watch only the players wearing black shirts and to count the number of times the team passed the ball. During the video a person in a gorilla suit walks through the scene. The film was projected onto a large screen (3.2 m X 2.4 m) and the participants sat in a chair 6 meters from the screen. The eye movement and fixations of the participants were recorded during the video and afterward the participants answered a series of questions.

Only 40% of the participants reported seeing the gorilla, leaving 60% who did not report seeing the gorilla. There was no significant difference in accuracy of the counting between the two groups. Analyzing the eye movement and fixation data showed no significant difference in the time spent looking at the players (black or white) between the two groups. However, the 60% of participants who did not report seeing the gorilla spent an average of 25 frames (about one second) fixated on the gorilla, despite not perceiving it.[25]

A more common example of the above is illustrated in the game of Three-card Monte.

Another experiment conducted by Daniel Memmert tested the effects of different levels of expertise can have on inattentional blindness. The participants in this experiment included six different groups: Adult basketball experts with an average of twelve years of experience, junior basketball experts with an average of five years, children who had practiced the game for an average of two years, and novice counterparts for each age group. In this experiment the participants watched the invisible gorilla experiment video. The participants were instructed to watch only the players wearing white and to count the number of times the team passed the ball.

The results of the experiment showed that experts did not count the number of passes more accurately than novices but did show that adult subjects were more accurate than the junior and children subjects. A much higher percentage of experts noticed the gorilla compared to novices and even the practiced children. 62% of the adult experts and 60% of the junior experts noticed the gorilla, suggesting that the difference between five and twelve years of experience has minimal effect on inattentional blindness. However, only 38% of the adult, 35% of the junior, and none of the children novices noticed the gorilla. Only 18% of the children with two years of practice noticed. This suggests that both age and experience can have a significant effect on inattentional blindness.[25]

Arien Mack and Irvin Rocks concluded in 1998 that no conscious perception can occur without attention.[1] Evidence through research on inattentional blindness contemplates that it may be possible that inattentional blindness reflects a problem with memory rather than with perception.[1] It is argued that at least some instances of inattentional blindness are better characterized as memory failures than perceptual failures. The extent to which unattended stimuli fail to engage perceptual processing is an empirical question that the combination of inattentional blindness and other various measures of processing can be used to address.[2]

The theory behind inattentional blindness research suggests that we consciously experience only those objects and events to which we directly attend.[1] That means that the vast majority of information in our field of vision goes unnoticed. Thus if we miss the target stimulus in an experiment, but are later told about the existence of the stimulus, this sufficient awareness allows participants to report and recall the stimulus now that attention has been allocated to it.[2] Mack and Rock, and their colleagues discovered a striking array of visual events to which people are inattentionally blind.[1] However the debate arises whether this inattentional blindness was due to memory or perceptual processing limitations.

Mack and Rock note that explanations for inattentional blindness can reflect a basic failure of perceptual processes to be engaged by unattended stimuli. Or that it may reflect a failure of memorial processes to encode information about unattended stimuli. It is important to note that the memory failure does not have to do with forgetting something that has been encoded by losing access to the memory of the stimulus from time of presentation to time of retrieval, rather that the failure is attributed to information not being encoded when the stimulus was present.[1] It seems that inattentional blindness can be explained by both memory and perceptual failures because in experimental research participants may fail to report what was on display due to failures in encoded information (memory) or a failure in perceptually processed information (perception).[1]

There are similarities in the types of unconscious processing apparent in inattentional blindness and in neuropsychological syndromes such as visual neglect and extinction. The analogy between these phenomenons seems to generate more questions as well as answers. These answers are fundamental for our understanding of the relationship between attention, stimulus coding and behavior.

Research has shown that some aspects of the syndrome of unilateral visual neglect appear to be similar to normal subjects in a state of inattentional blindness. In neglect, patients with lesions to the parietal cortex fail to respond to and report stimuli presented on the side of space contralateral to damage.[10][26] That is, they appear to be functionally blind to a range of stimuli. Since such lesions do not result in any sensory deficits, shortcomings have been explained in terms of a lack of attentional processing, for which the parietal cortex plays a large role.[27] These phenomena draw strong parallels to one another, as in both cases stimuli are perceptible but unreported when unattended.

In the phenomenon of extinction, patients can report the presence of a single stimulus presented on the affected side, but then fail to detect it when a second stimulus is presented simultaneously on the "good" (ipsilateral) side.[28] Here the stimulus on the affected side seems to lose under conditions of attentional competition from stimuli in the ipsilesional field.[28] The consequence of this competition is that the extinguished items may not be detected.

Similar to studies of inattentional blindness, there is evidence of processing taking place in the neglected field. For example, there can be semantic priming from a stimulus presented in the neglected field, which affects responses to stimuli subsequently presented on the unimpaired side.[29] Apparently in both neglect and inattentional blindness, there is some level processing of stimuli even when they are unattended.[29] However one major difference between neuropsychological symptoms such as neglect and extinction, and inattentional blindness concerns the role of expectation.[29] In inattentional blindness, subjects do not expect the unreported stimulus. In contrast, in neglect and extinction, patients may expect a stimulus to be presented on the affected side but still fail to report it when another it may be that expectation affects reportability but not the implicit processing of stimuli.[29]

Further explanations of the phenomenon of inattentional blindness include inattentional amnesia, inattentional agnosia and change blindness.

An explanation for this phenomenon is that observers see the critical object in their visual field but fail to process it extensively enough to retain it. Individuals experience inattentional agnosia after having seen the target stimuli but not consciously being able to identify what the stimuli is. It is possible that observers are not even able to identify that the stimuli they are seeing are coherent objects.[30] Thus observers perceive some representation of the stimuli but are actually unaware of what that stimulus is. It is because the stimulus is not encoded as a specific thing, that it later is not remembered. Individuals fail to report what the stimuli is after it has been removed. However, despite a lack in ability to fully process the stimuli, experiments have shown a priming effect of the critical stimuli. This priming effect indicates that the stimuli must have been processed to some degree, this occurs even if observers are unable to report what the stimuli is.[31]

Inattentional blindness is the failure to see a stimulus, such as an object that is present in a visual field. However, change blindness is the failure to notice something different about a visual display. Change blindness is a directly related to memory, individuals who experience the effects of change blindness fail to notice something different about a visual display from one moment to the next.[4] In experiments that test for this phenomenon participants are shown an image that is then followed by another duplicate image that has had a single change made to it. Participants are asked to compare and contrast the two images and identify what the change is. In inattentional blindness experiments, participants fail to identify some stimulus in a single display, a phenomenon that doesnt rely on memory the way change blindness does.[4] Inattentional blindness refers to an inability to identify an object all together where as change blindness is a failure to compare a new image or display to one that was previously stored in memory.[4]

In 2006, Daniel Memmert conducted a series of studies in which he tested the how age and expertise of participants affect inattentional blindness. Using the gorilla video, he tested 6 different groups of participants. There were 2 groups of children (average age=7) half with no experience in basketball, and the other half with 2 years experience; 2 groups of juniors (average age=13) half with no experience in basketball, and the other half with 5 years of experience; and 2 groups of adults (average age = 24) half with no experience in basketball, the other half with over 12 years of experience. He then instructed all the groups to keep track of how many passes the people on the black team made.

Overall, the children with or without any basketball experience failed to perceive the gorilla more than the juniors or the adults. There were no significant difference between the inexperienced junior and adult groups, or between the experienced junior and adult groups.[32] This pattern of results suggests that until the approximate age of 13, presumably because certain aspects of cognition are still under development, inattentional blindness occurrences are more frequent, but become consistent throughout the remainder of the life span.

Additionally, the juniors with basketball experience noticed the gorilla significantly more than the juniors with no basketball experience; and the group of experienced adults noticed the gorilla significantly more than the non-experienced adults. This suggests that if one has had much experience with the stimuli in a visual field, they are more likely to consciously perceive the unexpected object.

A series of studies conducted to test how similarity can influence the perception of a present stimulus. In the study, they asked participants to fixate on a central point on a computer screen and count how many times either white or black letters bounced off the edges of the screen. The first 2 trials did not contain an unexpected event, but the third trial was the critical trial in which a cross that had the same dimensions as the letters and varied in colour (white/light gray/dark gray/black) moved from the right side of the screen to the left side and passed through the central point. The results revealed the following: during the critical event, the more similar the colour of the cross was to the colour of the attended letters, the more likely the participants were to perceive it, and the less similar the colour of the cross was to the attended colour decreased the likelihood of the cross being noticed. For the participants attending to the black letters, 94% perceived the black cross; 44% perceived the dark gray cross; 12% perceived the light gray cross, and only 6% perceived the white cross. Similarly, if the participant was attending to the white letters, they were more likely to notice the cross it was white (94%) than if it was light gray (75%), dark gray (56%), or black (0%).[33] This study demonstrates that the more similar an unexpected object is to the attended object, the more likely it is to be perceived, thus reducing the chance of inattentional blindness.

The research that has been done on inattentional blindness suggests that there are four possible causes for this phenomenon. These include: conspicuity, mental workload, expectations, and capacity.[34]

Conspicuity refers to an object's ability to catch a person's attention. When something is conspicuous it is easily visible. There are two factors which determine conspicuity: sensory conspicuity and cognitive conspicuity. Sensory conspicuity factors are the physical properties an object has. If an item has bright colors, flashing lights, high contrast with environment, or other attention-grabbing physical properties it can attract a persons attention much easier. For example, people tend to notice objects that are bright colors or crazy patterns before they notice other objects. Cognitive conspicuity factors pertain to objects that are familiar to someone. People tend to notice objects faster if they have some meaning to their lives. For example, when a person hears his/her name, their attention is drawn to the person who said it. The cocktail party effect describes the cognitive conspicuity factor as well. When an object isnt conspicuous, it is easier to be inattentionally blind to it. People tend to notice items if they capture their attention in some way. If the object isnt visually prominent or relevant, there is a higher chance that a person will miss it.

Mental workload is a person's cognitive resources. The amount of a person's workload can interfere with processing of other stimuli. When a person focuses a lot of attention on one stimulus, he/she focuses less attention on other stimuli. For example, talking on the phone while driving the attention is mostly focused on the phone conversation, so there is less attention focused on driving. The mental workload could be anything from thinking about tasks that need to be done to tending to a baby in the backseat. When people have most of their attention focused on one thing, they are more vulnerable to inattentional blindness. However, the opposite is true as well. When a person has a very small mental workload he/she is doing an everyday task the task becomes automatic. Automatic processing can lessen one's mental workload, which can lead to a person to missing the unexpected stimuli. Working memory also has an effect on inattentional blindness. Those that experience inattentional blindness are more likely to have a lower working memory capacity.

Working memory also contributes to inattentional blindness. Cognitive psychologists have examined the relationship between working memory and inattention, but evidence is inconclusive. For example, some researchers state that individuals that have more space in their working memory and those with stronger working memory are less likely to be susceptible to inattentional blindness. Other researchers state that working memory does not influence inattentional blindness because working memory does not influence all attentional processes. For example, research conducted by Bredemeier and Simons, participants were given working memory tasks and a sustained-attention task. The first working memory task required participants to indicate whether a combination of letters matched a previous combination of letters that appeared earlier on a computer screen. The second working memory task required participants to determine if a target letter was in the same position as previous letters. For the sustained-attention task, participants were asked to count how many times a white square touched the edges of a computer screen. Once the tasks were completed, researchers asked participants if they noticed anything else besides the white squares during the sustained-attention task. During the sustained-attention task, a grey cross moved around the screen during some of the trails. Results indicated that 70% of participants did notice the grey cross moving on the computer screen, suggesting working memory does not have an influence on susceptibility to inattentional blindness.

On the other hand, a follow-up study to the Bredemeiser and Simons was conducted to further explore the impact of working memory using another working memory task. For this study, participants were asked to complete a math problem, and a letter was presented after each problem. After completing the math problems, participants were asked to recall the series of letters in sequential order. This task served as a working memory measure. The same sustained attention task was completed after the working memory task. Using this method, only 27% of participants noticed the grey square. Researchers concluded that working memory does influence one's experience of attentional blindness, but not an individual's ability to handle the task demands. These two studies demonstrate the inconsistencies in the relationship between working memory and inattentional blindness.[35]

When a person expects certain things to happen, he/she tends to block out other possibilities. This can lead to inattentional blindness. For example, person X is looking for their friend at a concert, and that person knows their friend (person Y) was wearing a yellow jacket. In order to find person Y, person X looks around for people wearing yellow. It is easier to pick a color out of the crowd than a person. However, if person Y took off the jacket, there is a chance person X could walk right past person Y and not notice because he/she was looking for the yellow jacket. Because of expectations, experts are more prone to inattentional blindness than beginners. An expert knows what to expect when certain situations arise. Therefore, that expert will know what to look for. This could cause that person to miss out on other important details that he/she may not have been looking for.

Attentional capacity, or neurological salience, is a measure of how much attention must be focused to complete a task. For example, an expert pianist can play a piano without thinking much, but a beginner would have to consciously think of every note they hit. This capacity can be lessened by drugs, alcohol, fatigue, and age. With a small capacity, it is more possible to miss things. Therefore, if a person is drunk, he/she will probably miss more than a sober person would. If your attentional capacity is large, you are less likely to experience inattentional blindness.

William James addressed the benefits of attention by saying, "Only those items which I notice shape my mind without selective interest, experience is utter chaos".[36] Humans have a limited mental capacity that is incapable of attending to all the sights, sounds and other inputs that rush the senses every moment. Inattentional blindness is beneficial in the sense that it is a mechanism that has evolved with attention to help filter out irrelevant input, allowing only important information to reach consciousness.[36] Several researchers, notably James J. Gibson, have argued that, even before the retina, perception begins in the ecology, which has turned perceptual processes into informational relationships in the environment through evolution.[37] This allows humans to focus our limited mental resources more efficiently in our environment. For example, New et al. maintain that survival required monitoring animals, both human and non-human, to become part of the evolutionary adaptiveness of the human species. They found that when participants were shown an image with a rapidly altering scene where the scene change included an animate or inanimate object that the participants were significantly better at identifying humans and animals. New et al. argue that better performance in detecting animals and humans is not a factor of acquired expertise, rather it is an evolved survival mechanism in human perception.[37]

Although the bulk of inattentional blindness research has been conducted in laboratory studies, the phenomenon occurs in a variety of everyday contexts. Depending upon the context, the occurrence of inattentional blindness could range from embarrassing and/or humorous to potentially devastating.

Several recent studies of explicit attention capture have found that when observers are focused on some other object or event, they often experience inattentional blindness.[38] This finding has potentially tragic implications for distracted driving. If a persons attention is focused elsewhere while driving, carrying on a conversation or text messaging, for example, they could fail to notice salient and distinctive objects, such as a stop sign, which could lead to serious injury and possibly even death. There have also been heinous incidents attributed to inattentional blindness behind the wheel. For example, a Pennsylvania highway crew accidentally paved over a dead deer that was lying on the road. When questioned regarding their actions, the workers claimed to have never seen it.[39]

Many policies are being implemented around the world to decrease the competition for explicit attention capture while operating a vehicle. For example, there are legislative efforts in many countries aimed at banning or restricting the use of cell phones while driving. Research has shown that the use of both hands-free and hand-held cellular devices while driving results in the failure of attention to explicitly capture other salient and distinctive objects, leading to significantly delayed reaction times, as well as inattentional blindness.[40] A study published in 1997, based on accident data in Toronto, found the risk involved in driving while using a cell phone to be similar to that of driving drunk. In both cases, the risk of a collision was three to six times higher compared to a sober driver not using a cell phone.[41] Moreover, Strayer et al. (2003) found that when controlling for driving difficulty and time on task, cell-phone drivers exhibited greater impairment than intoxicated drivers, using a high-fidelity driving simulator.[42]

Inattentional blindness is also prevalent in aviation. The development of heads-up display (HUD) for pilots, which projects information onto the windshield or onto a helmet-mounted display, has enabled pilots to keep their eyes on the windshield, but simulator studies have found that HUD may cause runway incursion accidents, where one plane collides with another on the runway.[36] This finding is particularly concerning because HUDs are being employed in automobiles, which could lead to potential roadway incursions.[36] When a particular object or event captures attention to the extent to which the beholders attentional capacity is completely absorbed, the resulting inattentional blindness has been known to cause dramatic accidents. For example, an airliner crew, engrossed with a blinking console light, failed to notice the approaching ground and register hearing the danger alarm sounding before the airliner crashed.[36]

Collaborative efforts to establish links between science and illusion have examined the relationship of the processes underlying inattentional blindness and the concept of misdirectiona magicians ability to manipulate attention in order to prevent his/her audience from seeing how a trick was performed. In several misdirection studies, including Kuhn and Tatler (2005),[43] participants watch a "vanishing item" magic trick. After the initial trial, participants are shown the trick until they detect the item dropping from the magicians hand. Most participants see the item drop on the second trial. The critical analyses involved differences in eye movements between the detected and undetected trials. These repetition trials are similar to the full-attention trial in the inattentional blindness paradigm, as both involve the detection of the unexpected event and, by detecting the unexpected event on the second trial, demonstrate that the event is readily perceivable.[44]

The main difference between inattentional blindness and misdirection involves how attention is manipulated. While inattentional blindness tasks require an explicit distractor, the attentional distraction in misdirection occurs through the implicit yet systematic orchestration of attention.[45] Moreover, there are several varieties of misdirection and different types are likely to induce different cognitive and perceptual processes, which vary the misdirection paradigms resemblance to inattentional blindness.[45]

Although the aims of magic and illusion differ from those of neuroscience, magicians wish to exploit cognitive weaknesses, whereas neuroscientists seek to understand the brain and the neuronal significance of cognitive functions. Several researchers have argued that neuroscientists and psychologists can learn from incorporating the real world experience and knowledge of magicians into their fields of research. The techniques developed over centuries of stage magic by magicians may also be utilized by neuroscience as powerful probes of human cognition.[46]

When a police officer's version of events differs from video or forensic evidence, inattentional blindness has been used by defense lawyers as a possibility.[47] The criticism of this defense is that this view could be used to defend nearly any police shooting.[48]

See the article here:
Inattentional blindness - Wikipedia, the free encyclopedia

Sports Medicine

URMC Sports Medicine, a program at URMC Orthopaedics and Rehabilitation, offers the latest in medical and surgical care to prevent, evaluate, treat, and rehabilitate injuries for both recreational and competitive athletes of all ages. We also help people with active jobs who sometimes suffer the same injuries and need the same care.

URMC Sports Medicine is the only medical practice in the Rochester, NY nine-county region dedicated soley to sports medicine. Our physicians are fellowship-trained sports medicine primary care physicians and orthopaedic surgeons. They work together with physical therapists and athletic trainers to provide complete medical care for patients.

Our physicians assistants, physical therapists, and athletic trainers have completed extensive training in the management of the full array of orthopaedic conditions. All critical resources for treatment and aftercare of sports injuries are available at Clinton Crossings in Brighton, South Pointe Landing in Greece or at the Platinum Office Complex in Penfield.

We are the sports medicine provider for athletes from many of the area high schools, and the official team doctors for athletes from local colleges and professional teams.

Our state-of-the-art Sports and Spine Rehabilitation center features an indoor track, weight machines, free weights, and a special area to work on golf, baseball, tennis, and basketball skills. In addition, we offer special services that allow you to contact our physicians any day, at any hour to consult on the best course of urgent care and treatment. And during normal office hours, we can arrange for a same-day appointment.

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Sports Medicine - URMC Orthopaedics and Rehabilitation ...

The Ochsner Sports Medicine Institute provides a comprehensive and coordinated multidisciplinary approach to the treatment of sports- and fitness-related injuries. The Institute is a one-stop-shop where you will find specially-trained physicians, the latest diagnostic imaging technology and outpatient rehabilitation making it easier and more convenient to return to your desired activity level. It also provides preventive care through the promotion of wellness, fitness, performance enhancement and education.

Conditions Treated:

The Ochsner Sports Medicine Institute is the source for comprehensive care of sports and fitness-related injuries and preventive care including fitness, wellness, athletic performance enhancement, and patient education. We offer physician services, diagnostic imaging, outpatient rehabilitation and physical therapy and wellness all conveniently located in one location

New Expansive Therapy Gymnasium The new gymnasium will include the most advanced therapy equipment (Cybex, Sports Art, Nautilus, Triton, and Game Ready equipment). Future plans will also include the Biodex 4 and Vestibular Unit for research and testing of patients.

Hydroworx Rehabilitation Pool This is a treadmill-in-a-pool, complete with underwater cameras that allow physicians to view their patients running gait and then assess therapies on the spot. This is typically used to treat any sports medicine-related injury, post operatively and non-operative. It will likewise utilize the benefits of aquatic therapy to speed recovery and return the athlete to full performance in a much faster time frame.

MRI Suite Coming soonThis MRI Suite will contain a 1.7 Tesla Unit that will be used to detect acute, subacute and chronic musculoskeletal injuries with high resolution. A skilled musculoskeletal radiologist will be on site to read these studies in real time and will be available for intra-articular gadolinium enhanced complex evaluations of specific joints such as the shoulder, hip, wrist, elbow and knee. In addition, state-of-the-art cartilage-specific T2 mapping will be available daily.

Human Performance Lab Coming soonThis lab will conduct clinical studies that analyze sports biomechanics, perform gait and running assessments, analyze pitching and throwing mechanics, and assess overall pre- and post-operative joint kinetics/kinematics and clinical outcomes. Motion and force assessments can be performed on specific joints (shoulder, below and knee) while changing internal and external forces, as demonstrated by low handicap golfers aiming to improve their technique. This information will create an extensive database through which rehabilitative protocols can be designed. This same biomechanical data base can be used to evaluate the effects of orthopaedic devices and procedures.

Concussion Management Program

The Ochsner Concussion Management Program is the first of its kind in Louisiana. Our program is designed to tailor rehabilitation to an individual's specific needs. Patients are assessed by board-certified physicians experienced in the field of concussion management. Following evaluation and assessment, patients will receive prompt treatment, including medical care from a physician, ongoing services (e.g., serial assessment, concussion education, counseling, return to play surveillance, cognitive therapy) if neccessary, a referral to our extensive network of additional pediatric specialists and ancillary medical professionals. An individualized approach to developing an appropriate Return to Play protocol is emphasized.

Our program utilizes a state-of-the-art computerized neurocognitive assessment, called ImPACT. It is currently used for professional athletes including those in the NFL, NHL, NASCAR, professional boxing and over 400 colleges and universities across the country. The use of computerized neurocognitive assessment enables our doctors to conduct a simple, 25-minute evaluation of an athlete's neurocognitive status ( i.e., memory, processing speed and other related functions) following concussion. Athletes/patients in this clinic will also undergo a broader neurologic and physical examination in order to ensure that all the information needed for the proper evaluation and treatment of mild head trauma is obtained. The program's primary focus is on expediting the concussed athlete's safe return to the field of play using the most current, up-to-date guidelines in concussion management. In doing this, we aim to significantly reduce the athlete's risk of repeat concussion, prolonged recovery time, long-term neuro-cognitive deficits and potential catastrophic events such as second - impact syndrome.

Click here for a brochure about the services and benefits provided by Ochsners Athletic Training Outreach Program.

Expect the finest care from Ochsner Sports Medicines Athletic Training Outreach Program

Benefits to your school or events

Professional Sports

Universities and Colleges

High Schools and Middle Schools

Community Outreach and Event Support

For information about the Athletic Training Outreach Program, contracts or other services, contact:

Chris Young, MAT, ATC, LAT, CSCS Coordinator - Athletic Training Outreach Program Ochsner Sports Medicine Institute 1201 S. Clearview Parkway, Suite 104 Jefferson, LA 70121 504-736-4615 ChrYoung@ochsner.org

For an appointment with one of our sports health physicians, please call:

Ochsner Sports Medicine Institute 504-736-4800

Colleen Amedee, LAT, ATC Outreach Athletic Trainer for Ben Franklin High School

Mark Armour II, MS, LAT, ATC Outreach Assistant Athletic Trainer

Jeanne Baldwin, LAT, ATC Outreach Athletic Trainer for Pearl River High School

Jeff Berger, LAT, ATC Outreach Athletic Trainer for John Curtis Christian School

Cyd Bertrand, LAT, ATC Outreach Athletic Trainer for Ursuline Academy

Jordan Blough, LAT, ATC

Coordinator - Athletic Training Outreach Program Ochsner Sports Medicine Institute

1201 S. Clearview Parkway, Suite 104 Jefferson, LA 70121 504-736-4615 Jblough@ochsner.org

Kim Brou, LAT, ATC Outreach Athletic Trainer for Bonnabel High School

Russ Carlisle, LAT, ATC Outreach Athletic Trainer for L.W. Higgins High School

Allan Chase, MS, LAT, ATC Outreach Athletic Trainer for University of New Orleans

Delesseps Dolese, MS, LAT, ATC Outreach Athletic Trainer forSalmen High School

Dan Doucet, MS, LAT, ATC, LCEP Outreach Athletic Trainer for John Ehret High School

Nicole Dufrene, LAT Outreach Athletic Trainer for Lusher Charter School

James Edelman, MS, LAT, ATC Outreach Athletic Trainer for St. Augustine High School

Benjamin Evans, MS, LAT, ATC, CES Outreach Athletic Trainer for East Jefferson High School

Christie Findley, MS, LAT, ATC PRN

Tiffany Gary, MHRD, LAT, ATC Outreach Athletic Trainer for Baton Rouge Community College

Summer Gebhart, MS, LAT, ATC Outreach Athletic Trainer for Grace King High School

Chuck Haaga, LAT, ATC, CSCS Outreach Athletic Trainer for Slidell High School

Michelle Harrell Anthony, LAT, ATC Outreach Trainer for Mandeville High School

Anthony Johnson, LAT PRN

Becky Mihalovits, MS, LAT, ATC Outreach Athletic Trainer for Helen Cox High School

Amanda Palazola, ATC, LAT Outreach Trainer for Northshore High School

Ryan Pickert, LAT, ATC Outreach Athletic Trainer for West Jefferson High School

David Pilet, LAT Outreach Athletic Trainer for Lakeshore High School

Raymond Raphael, LAT, ATC, LPN Outreach Athletic Trainer for Delgado Community College

Courtney Rauschkolb, LAT, ATC Outreach Athletic Trainer for Academy of Our Lady, Ecole Classique, St. Katherine Drexel Preparatory School and Louisiana Fire Soccer Club

Eric Richardson, MS, LAT, ATC, CES, PES Outreach Athletic Trainer for Archbishop Hannan High School

Nichole Saverino, MS, LAT, ATC Outreach Athletic Trainer for Dillard University

Kacie Sommerfeld, LAT, ATC Outreach Athletic Trainer for Riverdale High School

Brad Steverson, LAT, ATC Outreach Athletic Trainer

Reggie Stone, MS, LAT, ATC Outreach Assistant Athletic Trainer for New Orleans Saints

Erica Taylor, MS, LAT, ATC, CES Outreach Athletic Trainer for University of New Orleans

Melina Todesco, MA, LAT, ATC Outreach Athletic Trainer for Haynes Academy for Advanced Studies and Patrick F. Taylor Science & Technology Academy

Kristina Tyson, LAT, ATC Outreach Athletic Trainer for St. Martin's Episcopal School

Britt Vallot, LAT, ATC Outreach Athletic Trainer for Dillard University

Allison Wood, MBA, LAT, ATC Outreach Athletic Trainer for Xavier University

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Sports Medicine | Ochsner Health System

[To view information and photos about Rothman Institute's recent "Impact of Sports" conference please click this link]

Sports Medicine is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of injuries due to athletic activity. Many of these disorders are treated with arthroscopic surgery, a minimally invasive surgical method that utilizes a camera to look inside a joint and specialized instruments to carry out any necessary surgery in that joint.

The practice of sports medicine is a team approach with input from orthopaedic surgeon, non-surgical sports specialists, rehabilitation specialist, athletic trainer, and physical therapist. The internationally recognized Sports Medicine Center at the Rothman Institute is one of the worlds most trusted practices for the treatment of sports related injuries. Pioneers of advanced surgical equipment and innovative surgical techniques, our specialists evaluate over 40,000 sports injuries and perform more than 5,000 sports surgeries for athletes of all levels per year.

Rothman Institutes Sports Medicine team is the leading provider of sports medicine orthopaedic care in the region. Our team provides care for all levels of athletes including the Philadelphia Phillies, Philadelphia Eagles, USA Olympic Womens Gymnastics Team, Villanova University, Saint Josephs University Hawks, Rutgers University-Camden Raptors and dozens of regional high schools as well as the Philadelphia Marathon, Distance Run, and International Cycling Race.

If you are an athletic director, athletic trainer, or anyone who is tasked with finding coverage for an athletic program, team, or large scale sporting event, the Rothman Institute Sports Medicine Team can help you. Our team of physicians can provide medical coverage, clinics, and educational seminars for your athletes, coaches, and families.

Please contact Rich Sharpnack, Sports Medicine Services Manager, at rsharpnack@velocitysp.com for more information.

You can learn more by visiting the Women's Sports Medicine Program page here.

This is a center where patients can go the have their disabled joint biological resurfaced, realigned, and stabilized without having the joint replaced by artificial materials such as metal and plastic. It is well know that the outcomes of patients under the age of 50 undergoing artificial joint replacement are not as good as we would like. Therefore we feel the future of Orthopaedics is to try to restore a joint back to its original anatomy by realignment, ligament reconstruction, and cartilage restoration.

You can learn more by visiting the Cartilage Resoration Program page here.

The Hip Arthroscopy Program at the Rothman Institute is a part of the Hip Preservation Center. Hip arthroscopy is a unique, minimally invasive outpatient technique that uses fiber-optic cameras and small instruments to treat painful hip conditions that previously were repaired through larger open incisions. It can allow for a quicker recovery period, less scarring, and a return to pre-injury activity levels which make it an ideal technique for athletes and those under the age of 55.

You can learn more by visiting the Hip Arthroscopy Program page here.

The Sports Concussion Program at the Rothman Institute is led by our team of top sports medicine physicians who are specially trained in concussion evaluation, treatment, and management. Our physicians are Credentialed ImPACT Consultants (CIC) who utilize cutting-edge treatment options for our patients return-to-activity and return-to-play recovery protocol. Our comprehensive care promotes coordinated communication across all entities involved in the treatment process including athletic trainers, coaches, parents, school administrators and referring physicians, enabling our athletes to return to their pre-injury status as quickly as possible.

Rothman Institute is a clinical partner in the Jefferson Comprehensive Concussion Center, in the Navy Yard. Visit this link for more information.

Whether its throwing a javelin or pitching a baseball, the overhead or throwing athlete is exposed to tremendous forces during overhead sports. The Overhead/Throwing Athlete Program at the Rothman Institute is one of the first in the nation to focus on the particular health needs of these unique athletes. The team includes our world-class orthopaedic surgeons, non-operative sports medicine physicians, physical medicine and rehabilitation physicians, nutritionists, nurses, athletic trainers, and physical therapists. Research studies help us to identify those aspects of the overhead/throwing mechanism that are most demanding biomechanically as well as identifying those athletes potentially at risk for injury during this activity. This helps to create preventative conditioning and training programs to help them avoid injury.

You can learn more by visiting the OverheadThrowing Program page here.

Over the years Rothman Institute has really integrated Certified Athletic Trainers into its world-renowned private physician practice. If you look at the evolution of the job settings for Athletic Trainers, you will see Rothman captures both the traditional and the non-traditional setting. In the clinic Rothman Institute is utilizing ATs distinctive skill set as physician extenders and orthotic technicians. Our Field Athletic Trainers provide direct sports medicine care to youth, high school, college and professional athletes. Rothman ATs provide athletic training services throughout Southeastern PA and NJ to interscholastic high schools, colleges, as well as tournaments and special events.

You can learn more by visiting theAthletic Training - Sports Medicine Outreach Program here.

The Injury Prevention Program at the Rothman Institute is dedicated to the prevention of injuries from athletic participation, particularly youth sports. The goal is to help educate parents, coaches, healthcare providers and athletes on the importance of injury prevention, treatment, and long-term consequences of overuse and traumatic injuries. As the leading provider of sports medicine care in the region, we rely on a team approach from world-renowned orthopaedic surgeons, non-surgical sports specialists, rehabilitation specialists, athletic trainers, physical therapists, and performance experts to provide the same level of care we provide our professional sports teams. In addition to providing community education, our program is dedicated to research in the area of injury prevention to promote the safety of athletic participation.

You can learn more by visiting theInjury Prevention Program here.

You should see a doctor for an injury when...

Of course, if you are injured during the course of a sporting event it is always best to seek the advice of your team physician.Sports Medicine is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of injuries due to athletic activity. Many of these disorders are treated with arthroscopic surgery, a minimally invasive surgical method that utilizes a camera to look inside a joint and specialized instruments to carry out any necessary surgery in that joint.

Over the years Rothman Institute has really integrated Certified Athletic Trainers into its world-renowned private physician practice. If you look at the evolution of the job settings for Athletic Trainers, you will see Rothman captures both the traditional and the non-traditional setting. In the clinic Rothman Institute is utilizing ATs distinctive skill set as physician extenders and orthotic technicians. Our Field Athletic Trainers provide direct sports medicine care to youth, high school, college and professional athletes. Rothman ATs provide athletic training services throughout Southeastern PA and NJ to interscholastic high schools, colleges, as well as tournaments and special events.

Certified Athletic Trainers can schedule appointments for their athletes by using our ATC Appointment Form.

[To view information and photos about Rothman Institute's recent "Impact of Sports" conference please click this link]

Sports Medicine is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of injuries due to athletic activity. Many of these disorders are treated with arthroscopic surgery, a minimally invasive surgical method that utilizes a camera to look inside a joint and specialized instruments to carry out any necessary surgery in that joint.

The practice of sports medicine is a team approach with input from orthopaedic surgeon, non-surgical sports specialists, rehabilitation specialist, athletic trainer, and physical therapist. The internationally recognized Sports Medicine Center at the Rothman Institute is one of the worlds most trusted practices for the treatment of sports related injuries. Pioneers of advanced surgical equipment and innovative surgical techniques, our specialists evaluate over 40,000 sports injuries and perform more than 5,000 sports surgeries for athletes of all levels per year.

Rothman Institutes Sports Medicine team is the leading provider of sports medicine orthopaedic care in the region. Our team provides care for all levels of athletes including the Philadelphia Phillies, Philadelphia Eagles, USA Olympic Womens Gymnastics Team, Villanova University, Saint Josephs University Hawks, Rutgers University-Camden Raptors and dozens of regional high schools as well as the Philadelphia Marathon, Distance Run, and International Cycling Race.

If you are an athletic director, athletic trainer, or anyone who is tasked with finding coverage for an athletic program, team, or large scale sporting event, the Rothman Institute Sports Medicine Team can help you. Our team of physicians can provide medical coverage, clinics, and educational seminars for your athletes, coaches, and families.

Please contact Rich Sharpnack, Sports Medicine Services Manager, at rsharpnack@velocitysp.com for more information.

You can learn more by visiting the Women's Sports Medicine Program page here.

This is a center where patients can go the have their disabled joint biological resurfaced, realigned, and stabilized without having the joint replaced by artificial materials such as metal and plastic. It is well know that the outcomes of patients under the age of 50 undergoing artificial joint replacement are not as good as we would like. Therefore we feel the future of Orthopaedics is to try to restore a joint back to its original anatomy by realignment, ligament reconstruction, and cartilage restoration.

You can learn more by visiting the Cartilage Resoration Program page here.

The Hip Arthroscopy Program at the Rothman Institute is a part of the Hip Preservation Center. Hip arthroscopy is a unique, minimally invasive outpatient technique that uses fiber-optic cameras and small instruments to treat painful hip conditions that previously were repaired through larger open incisions. It can allow for a quicker recovery period, less scarring, and a return to pre-injury activity levels which make it an ideal technique for athletes and those under the age of 55.

You can learn more by visiting the Hip Arthroscopy Program page here.

The Sports Concussion Program at the Rothman Institute is led by our team of top sports medicine physicians who are specially trained in concussion evaluation, treatment, and management. Our physicians are Credentialed ImPACT Consultants (CIC) who utilize cutting-edge treatment options for our patients return-to-activity and return-to-play recovery protocol. Our comprehensive care promotes coordinated communication across all entities involved in the treatment process including athletic trainers, coaches, parents, school administrators and referring physicians, enabling our athletes to return to their pre-injury status as quickly as possible.

Rothman Institute is a clinical partner in the Jefferson Comprehensive Concussion Center, in the Navy Yard. Visit this link for more information.

Whether its throwing a javelin or pitching a baseball, the overhead or throwing athlete is exposed to tremendous forces during overhead sports. The Overhead/Throwing Athlete Program at the Rothman Institute is one of the first in the nation to focus on the particular health needs of these unique athletes. The team includes our world-class orthopaedic surgeons, non-operative sports medicine physicians, physical medicine and rehabilitation physicians, nutritionists, nurses, athletic trainers, and physical therapists. Research studies help us to identify those aspects of the overhead/throwing mechanism that are most demanding biomechanically as well as identifying those athletes potentially at risk for injury during this activity. This helps to create preventative conditioning and training programs to help them avoid injury.

You can learn more by visiting the OverheadThrowing Program page here.

Over the years Rothman Institute has really integrated Certified Athletic Trainers into its world-renowned private physician practice. If you look at the evolution of the job settings for Athletic Trainers, you will see Rothman captures both the traditional and the non-traditional setting. In the clinic Rothman Institute is utilizing ATs distinctive skill set as physician extenders and orthotic technicians. Our Field Athletic Trainers provide direct sports medicine care to youth, high school, college and professional athletes. Rothman ATs provide athletic training services throughout Southeastern PA and NJ to interscholastic high schools, colleges, as well as tournaments and special events.

You can learn more by visiting theAthletic Training - Sports Medicine Outreach Program here.

The Injury Prevention Program at the Rothman Institute is dedicated to the prevention of injuries from athletic participation, particularly youth sports. The goal is to help educate parents, coaches, healthcare providers and athletes on the importance of injury prevention, treatment, and long-term consequences of overuse and traumatic injuries. As the leading provider of sports medicine care in the region, we rely on a team approach from world-renowned orthopaedic surgeons, non-surgical sports specialists, rehabilitation specialists, athletic trainers, physical therapists, and performance experts to provide the same level of care we provide our professional sports teams. In addition to providing community education, our program is dedicated to research in the area of injury prevention to promote the safety of athletic participation.

You can learn more by visiting theInjury Prevention Program here.

You should see a doctor for an injury when...

Of course, if you are injured during the course of a sporting event it is always best to seek the advice of your team physician.Sports Medicine is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of injuries due to athletic activity. Many of these disorders are treated with arthroscopic surgery, a minimally invasive surgical method that utilizes a camera to look inside a joint and specialized instruments to carry out any necessary surgery in that joint.

Over the years Rothman Institute has really integrated Certified Athletic Trainers into its world-renowned private physician practice. If you look at the evolution of the job settings for Athletic Trainers, you will see Rothman captures both the traditional and the non-traditional setting. In the clinic Rothman Institute is utilizing ATs distinctive skill set as physician extenders and orthotic technicians. Our Field Athletic Trainers provide direct sports medicine care to youth, high school, college and professional athletes. Rothman ATs provide athletic training services throughout Southeastern PA and NJ to interscholastic high schools, colleges, as well as tournaments and special events.

Certified Athletic Trainers can schedule appointments for their athletes by using our ATC Appointment Form.

View post:
Sports Medicine : Rothman Institute Orthopaedics

The Division of Community Pediatrics and Preventive Medicine at Nicklaus Children's Hospital, formerly Miami Children's Hospital, was founded in 1991 to enhance the health and well being of the children of South Florida. The division advances the hospitals commitment to all children of the region, through advocacy, health promotion, and community outreach to promote prevention of illness and early identification of life-threatening diseases. Program components include:

Nicklaus Children's Hospital, formerly Miami Children's Hospitals Division of Community Pediatrics and Preventive Medicine provides medical outreach through a variety of programs to bring healthcare to children in need.

Division of Community Pediatrics and Preventive Medicine

Mission and Vision

Mission: To provide early, accessible preventive and interventional health services to improve the health status of children and adolescents in South Florida by early identification of risk factors that affect their health through the implementation of clinical, educational and research programs.

Vision: Nicklaus Children's Hospital, formerly Miami Children's Hospital, will be recognized as a national leader in disease prevention, health policy/advocacy and health promotion efforts by addressing the health needs of children and adolescents. This vision will be driven by ongoing monitoring, assessment leading to policy-making oriented towards the prevention of diseases and related risk factors, therefore improving morbidity and mortality rates

School-Based Programs

The Nicklaus Children's Hospital, formerly Miami Children's Hospital, Division of Community Pediatrics and Preventive Medicine is partnering with The Childrens Trust of Miami-Dade County to offer school-based health clinics, as part of the Health Connect in Our Schools Program.

This initiative, which provides a nurse practitioner and licensed practical nurse (LPN) at high-risk schools, provides preventive and basic school health services in an effort to decrease absenteeism and improve health outcomes of the student population. The program also seeks to assign medical homes for children without a pediatrician.

Services offered through the program include:

For more information on this program, please call 305-663-6800.

The Division of Community Pediatrics and Preventive Medicine offers a variety of health and safety classes and programs for parents, caregivers and children. Topics and programs include:

For more information on this program, please call 305-663-6800.

Injury Prevention Program/SafeKids

Locally the program focuses on reducing injuries to children by promoting and educating the community on child passenger safety, pedestrian/bike and wheeled sport safety and water/ drowning prevention, among other important safety topics. The passenger safety Buckle Up Program funded through SafeKids USA and the General Motors Foundation has been widely recognized by the Department of Pedestrian Safety, the State Department of Health, as well as nationally by the Department of Transportation and by the Institute of Health for Latino Children through the Corazon de mi Vida Car Seat Initiative.

These injury prevention programs have also been made possible in part from grants received from the Department of Transportation, the Ford Motor Company, United Automobile Insurance Company and SafeKids USA.

Nicklaus Children's Hospital, formerly Miami Children's Hospital, has opened the first Car Seat Check Station for parents to ensure appropriate sizing and fitting of their childrens car safety devices.

For more information, please call 305-663-6800.

Partnerships and Collaborations

The Division of Community Pediatrics and Preventive Medicine has forged partnerships with recognized local, state, national and international lead agencies in maternal/child health to include some of the following:

See more here:
Nicklaus Children's Hospital - Preventive Medicine

Nikhat Parveen, Ph.D. Associate Professor Office: ICPH-E350T Tel: 973-972-5218 Lab: ICPH-E-310N.1 Tel: 973-972-4437

Email: parveeni@njms.rutgers.edu

My laboratory is studying the molecular basis of pathogenesis of bacterial species, Borrelia burgdorferi, Treponema pallidum and Pseudomonas aeruginosa. These clinically important bacterial pathogens are transmitted to humans using different mechanisms and also show different disease manifestations. B. burgdorferi is transmitted by Ixodes tick vector, T. pallidum by sexual contact and P. aeruginosa, a ubiquitously present organism, is transmitted through ventilation or by direct contact of the patient with the contaminated source.

B. burgdorferi, a spirochete, is causative agent of Lyme disease, a multisystemic illness that affects various organs including joints, heart, nervous system and skin. If untreated, it may result in chronic disease with the symptoms including arthritis, acrodermatitis or neuroborreliosis. It is an extracellular pathogen often found adhering to the host cells in the biopsy specimens of the patients. We have been studying the molecular mechanisms involved in the attachment of Lyme disease spirochetes to a variety of host cells. The specific interaction between the spirochete and host cells may be responsible for the tissue tropism exhibited by B. burgdorferi. Our objective is to understand whether different B.burgdorferi adhesins show affinity for different host receptors on various host cells. We use genetics, biochemical techniques and tissue culture system to identify and characterize the bacterial and host molecules involved in this interaction in vitro. We have already identified two types of glycosaminoglycan receptors on mammalian cells that are recognized by several B. burgdorferi proteins and we are further characterizing this interaction. Mouse is a natural host of B. burgdorferi and C3H mice show several manifestations of Lyme disease observed in humans. We have recently adapted firefly luciferase-based detection system for B. burgdorferi. Using a combination of bioluminescent B. burgdorferi and mouse model of infection, we will further analyze the contribution of each bacterial ligand-host receptor interaction in Lyme pathogenesis. Tissue colonization by the spirochetes will be monitored non-invasively by employing in vivo imaging system. Recently, we have initiated studies to understand molecular basis of T. pallidum pathogenesis using this as a surrogate system.

P. aeruginosa is an opportunistic pathogen and produces a wide variety of virulence factors. It results in a variety of illnesses and is responsible for high morbidity and mortality in immunocompromised and elderly patients. Due to a highly adaptable nature of P. aeruginosa and its ability to survive even in detergents, it is a major contributor to infections in the hospital environment. We have been studying the quorum-sensing mediated induction of several virulence factors in this organism both as free-living organism and in association with its different hosts. We will assess the role of selected virulence factors in biofilm formation while P. aeruginosa is present in communities along with the other organisms. Our current focus is to investigate genetics of production and regulation of PrpL protease and pyocyanin pigment of P. aeruginosa and examine the roles of these virulence factors in tissue destruction. The roles of these two virulence factors in corneal damage, in burn wounds and in the cystic fibrosis patients will then be examined.

1988-1991 Scientist at IARI, New Delhi and Investigator in Indo-US Bilateral Program

1991-1995 Ph.D. in Microbiology, University of Hawaii at Manoa, Honolulu, HI

1996-Nov.00 Postdoctoral Fellow, mentor: John Leong, Univ. Mass. Med. School, MA

2000-May 05 Research Assistant Professor, Univ. Mass. Med. School, MA

Original post:
Microbiology & Molecular Genetics - Rutgers New Jersey ...

Cleveland Clinic Childrens Center for Pediatric Integrative Medicine is dedicated to addressing the increasing demand for integrative healthcare by researching and providing access to practices that address the physical as well as lifestyle, emotional, and spiritual needs of children. As the body of evidence for integrative medicine grows, we remain at the forefront of providing the most updated education and practices to our patients. We are able to care for children through their mid-20s, then provide seamless transition to adult providers.

Integrative Medicine services have become very popular in the United States, with more than 70 percent of Americans using them in some form.

Your child may benefit from integrative medicine as a complement to the care they are already receiving to treat chronic illness. Integrative medicine may help to reduce the severity or frequency of disease episodes, decrease stress related to chronic disease, and enjoy a better quality of life.

Our team members can coordinate appointments together to provide the patient with the best care.

Conditions that are commonly treated with integrative medicine include:

Our team of dedicated pediatric physicians and therapists are certified to perform a number of complementary therapies, including:

Increasingly, research shows that how we live, what we think, and how we feel affect our health. While conventional medicine can help diminish the consequences of unhealthy lifestyles, integrative medicine can reverse those consequences, prevent illness and reduce symptoms, resulting in:

Our team of dedicated pediatric physicians and therapists are certified to perform a number of complementary therapies, including:

The Center for Pediatric Integrative Medicine looks into the role of mind, body, spirit and lifestyle changes and how they can affect chronic disease. Studies yield evidence-based results that continue to encourage medical schools, hospitals and physicians to accept and incorporate these methods.

For example, research at Cleveland Clinic has shown that integrative medicine, including guided imagery, massage or Reiki, can help patients reduce their anxiety before surgery, to cope better with postoperative pain and to maximize their recovery.

To learn more, we invite you to explore research from the:

Read more:
Integrative Medicine - Cleveland Clinic

Stem cells are the building blocks of your skin. They have a unique ability to replace damaged and diseased cells. As they divide, they can proliferate for long periods into millions of new skin cells.

As we age, our stem cells lose their potency. Your skins ability to repair itself just isnt what it used to be. The result can be fine lines, wrinkles, age spots, and sagging skin. But non-embryonic stem cells the same stem cells active early in life are highly potent.

Emerge Skin Cares Anti-Aging Stem Cell Skin Care Serum tap into the potency of these stem cells to renew skin.

Scientists at Emerge Labs Stem Cell Skin Care discovered that human non-embryonic stem cell extracts can renew skin by replacing old cells with healthy new ones. These stem cell extracts stimulate your own skins abilities to repair itself. And Emerge anti-aging stem cell serums were born. Where Stem Cells in Anti Aging Products Come From The first types of human stem cells to be studied by researchers were embryonic stem cells, donated from in vitro fertilization labs. But because creating embryonic stem cells involves the destruction of a fertilized human embryo, many people have ethical concerns about the use of such cells.

The non-embryonic stem cells in Lifeline stem cell serums are derived from unfertilized human oocytes (eggs) which are donated to ISCO from in vitro fertilization labs and clinics. Emerge Anti Aging Stem Cell Skin Care is Based On Proven Scientific Research Emerge Skin Cares exclusive anti-aging products are a combination of several discoveries and unique high-technology, patent-pending formulations.

PhytoCellTecMalus Domestica the first plant stem cell activefor skin stem cell protection with proven efficacy PhytoCellTec Malus Domestica is a liposomal preparation of apple stem cells developed by a novel, patent pending plant cell culture technology.

PhytoCellTec a novel plant cell culture technology has been invented to cultivate dedifferentiated callus cells from a rare Swiss apple. These apple stem cells are rich in epigenetic factors and metabolites, assuring the longevity of skin cells. PhytoCellTec Malus Domestica has been shown to protect skin stem cells and delay the senescence of hair follicles.

PhytoCellTec Malus Domestica provides a revolutionary anti-aging performance for real rejuvenation.

Claims with PhytoCellTec Malus Domestica Protects longevity of skin stem cells Delays senescence of essential cells Combats chronological aging

PhytoCellTec Solar Vitis is based on stem cells derived from a specific grape cultivar that has been obtained through our unique PhytoCellTec technology. As we all know UV radiation is responsible for 80% of skin aging. Despite the use of sun protection filters, toxins and free radicals are generated by UV in the skin. This affects sensitive cells such as the epidermal stem cells which are essential and most valuable. The activity of skin stem cells is the key factor in ensuring the vitality and regeneration capacity of the skin. PhytoCellTec Solar Vitis both protects and maintains the activity of epidermal stem cells even in cases of stress induced by UV.

Claims with PhytoCellTecTM Solar VitisProtects skin stem cells against UV stress Delays senescence of essential cells Fights photo-aging For a vital and healthy-looking skin

See the original post here:
Stem Cell Skin Care | Science Meets Beauty

Nanobiotechnology, bionanotechnology, and nanobiology are terms that refer to the intersection of nanotechnology and biology.[1] Given that the subject is one that has only emerged very recently, bionanotechnology and nanobiotechnology serve as blanket terms for various related technologies.

This discipline helps to indicate the merger of biological research with various fields of nanotechnology. Concepts that are enhanced through nanobiology include: nanodevices (such as biological machines), nanoparticles, and nanoscale phenomena that occurs within the discipline of nanotechnology. This technical approach to biology allows scientists to imagine and create systems that can be used for biological research. Biologically inspired nanotechnology uses biological systems as the inspirations for technologies not yet created.[2] However, as with nanotechnology and biotechnology, bionanotechnology does have many potential ethical issues associated with it.

The most important objectives that are frequently found in nanobiology involve applying nanotools to relevant medical/biological problems and refining these applications. Developing new tools, such as peptoid nanosheets, for medical and biological purposes is another primary objective in nanotechnology. New nanotools are often made by refining the applications of the nanotools that are already being used. The imaging of native biomolecules, biological membranes, and tissues is also a major topic for the nanobiology researchers. Other topics concerning nanobiology include the use of cantilever array sensors and the application of nanophotonics for manipulating molecular processes in living cells.[3]

Recently, the use of microorganisms to synthesize functional nanoparticles has been of great interest. Microorganisms can change the oxidation state of metals. These microbial processes have opened up new opportunities for us to explore novel applications, for example, the biosynthesis of metal nanomaterials. In contrast to chemical and physical methods, microbial processes for synthesizing nanomaterials can be achieved in aqueous phase under gentle and environmentally benign conditions. This approach has become an attractive focus in current green bionanotechnology research towards sustainable development.[4]

The terms are often used interchangeably. When a distinction is intended, though, it is based on whether the focus is on applying biological ideas or on studying biology with nanotechnology. Bionanotechnology generally refers to the study of how the goals of nanotechnology can be guided by studying how biological "machines" work and adapting these biological motifs into improving existing nanotechnologies or creating new ones.[5][6] Nanobiotechnology, on the other hand, refers to the ways that nanotechnology is used to create devices to study biological systems.[7]

In other words, nanobiotechnology is essentially miniaturized biotechnology, whereas bionanotechnology is a specific application of nanotechnology. For example, DNA nanotechnology or cellular engineering would be classified as bionanotechnology because they involve working with biomolecules on the nanoscale. Conversely, many new medical technologies involving nanoparticles as delivery systems or as sensors would be examples of nanobiotechnology since they involve using nanotechnology to advance the goals of biology.

The definitions enumerated above will be utilized whenever a distinction between nanobio and bionano is made in this article. However, given the overlapping usage of the terms in modern parlance, individual technologies may need to be evaluated to determine which term is more fitting. As such, they are best discussed in parallel.

Most of the scientific concepts in bionanotechnology are derived from other fields. Biochemical principles that are used to understand the material properties of biological systems are central in bionanotechnology because those same principles are to be used to create new technologies. Material properties and applications studied in bionanoscience include mechanical properties(e.g. deformation, adhesion, failure), electrical/electronic (e.g. electromechanical stimulation, capacitors, energy storage/batteries), optical (e.g. absorption, luminescence, photochemistry), thermal (e.g. thermomutability, thermal management), biological (e.g. how cells interact with nanomaterials, molecular flaws/defects, biosensing, biological mechanisms s.a. mechanosensing), nanoscience of disease (e.g. genetic disease, cancer, organ/tissue failure), as well as computing (e.g. DNA computing). The impact of bionanoscience, achieved through structural and mechanistic analyses of biological processes at nanoscale, is their translation into synthetic and technological applications through nanotechnology.

Nano-biotechnology takes most of its fundamentals from nanotechnology. Most of the devices designed for nano-biotechnological use are directly based on other existing nanotechnologies. Nano-biotechnology is often used to describe the overlapping multidisciplinary activities associated with biosensors, particularly where photonics, chemistry, biology, biophysics, nano-medicine, and engineering converge. Measurement in biology using wave guide techniques, such as dual polarization interferometry, are another example.

Applications of bionanotechnology are extremely widespread. Insofar as the distinction holds, nanobiotechnology is much more commonplace in that it simply provides more tools for the study of biology. Bionanotechnology, on the other hand, promises to recreate biological mechanisms and pathways in a form that is useful in other ways.

Nanomedicine is a field of medical science whose applications are increasing more and more thanks to nanorobots and biological machines, which constitute a very useful tool to develop this area of knowledge. In the past years, researchers have done many improvements in the different devices and systems required to develop nanorobots. This supposes a new way of treating and dealing with diseases such as cancer; thanks to nanorobots, side effects of chemotherapy have been controlled, reduced and even eliminated, so some years from now, cancer patients will be offered an alternative to treat this disease instead of chemotherapy, which causes secondary effects such as hair lose, fatigue or nausea killing not only cancerous cells but also the healthy ones. At a clinical level, cancer treatment with nanomedicine will consist on the supply of nanorobots to the patient through an injection that will seek for cancerous cells leaving untouched the healthy ones. Patients that will be treated through nanomedicine will not notice the presence of this nanomachines inside them; the only thing that is going to be noticeable is the progressive improvement of their health.[8]

Nanobiotechnology (sometimes referred to as nanobiology) is best described as helping modern medicine progress from treating symptoms to generating cures and regenerating biological tissues. Three American patients have received whole cultured bladders with the help of doctors who use nanobiology techniques in their practice. Also, it has been demonstrated in animal studies that a uterus can be grown outside the body and then placed in the body in order to produce a baby. Stem cell treatments have been used to fix diseases that are found in the human heart and are in clinical trials in the United States. There is also funding for research into allowing people to have new limbs without having to resort to prosthesis. Artificial proteins might also become available to manufacture without the need for harsh chemicals and expensive machines. It has even been surmised that by the year 2055, computers may be made out of biochemicals and organic salts.[9]

Another example of current nanobiotechnological research involves nanospheres coated with fluorescent polymers. Researchers are seeking to design polymers whose fluorescence is quenched when they encounter specific molecules. Different polymers would detect different metabolites. The polymer-coated spheres could become part of new biological assays, and the technology might someday lead to particles which could be introduced into the human body to track down metabolites associated with tumors and other health problems. Another example, from a different perspective, would be evaluation and therapy at the nanoscopic level, i.e. the treatment of Nanobacteria (25-200nm sized) as is done by NanoBiotech Pharma.

While nanobiology is in its infancy, there are a lot of promising methods that will rely on nanobiology in the future. Biological systems are inherently nano in scale; nanoscience must merge with biology in order to deliver biomacromolecules and molecular machines that are similar to nature. Controlling and mimicking the devices and processes that are constructed from molecules is a tremendous challenge to face the converging disciplines of nanotechnology.[10] All living things, including humans, can be considered to be nanofoundries. Natural evolution has optimized the "natural" form of nanobiology over millions of years. In the 21st century, humans have developed the technology to artificially tap into nanobiology. This process is best described as "organic merging with synthetic." Colonies of live neurons can live together on a biochip device; according to research from Dr. Gunther Gross at the University of North Texas. Self-assembling nanotubes have the ability to be used as a structural system. They would be composed together with rhodopsins; which would facilitate the optical computing process and help with the storage of biological materials. DNA (as the software for all living things) can be used as a structural proteomic system - a logical component for molecular computing. Ned Seeman - a researcher at New York University - along with other researchers are currently researching concepts that are similar to each other.[11]

DNA nanotechnology is one important example of bionanotechnology.[12] The utilization of the inherent properties of nucleic acids like DNA to create useful materials is a promising area of modern research. Another important area of research involves taking advantage of membrane properties to generate synthetic membranes. Proteins that self-assemble to generate functional materials could be used as a novel approach for the large-scale production of programmable nanomaterials. One example is the development of amyloids found in bacterial biofilms as engineered nanomaterials that can be programmed genetically to have different properties.[13]Protein folding studies provide a third important avenue of research, but one that has been largely inhibited by our inability to predict protein folding with a sufficiently high degree of accuracy. Given the myriad uses that biological systems have for proteins, though, research into understanding protein folding is of high importance and could prove fruitful for bionanotechnology in the future.

Lipid nanotechnology is another major area of research in bionanotechnology, where physico-chemical properties of lipids such as their antifouling and self-assembly is exploited to build nanodevices with applications in medicine and engineering.[14]

This field relies on a variety of research methods, including experimental tools (e.g. imaging, characterization via AFM/optical tweezers etc.), x-ray diffraction based tools, synthesis via self-assembly, characterization of self-assembly (using e.g. dual polarization interferometry, recombinant DNA methods, etc.), theory (e.g. statistical mechanics, nanomechanics, etc.), as well as computational approaches (bottom-up multi-scale simulation, supercomputing).

Continued here:
Nanobiotechnology - Wikipedia, the free encyclopedia

Diabetes is a life-long disease that affects the way your body handles glucose, a kind of sugar, in your blood.

Most people with the condition have type 2. There are about 27 million people in the U.S. with it. Another 86 million have prediabetes: Their blood glucose is not normal, but not high enough to be diabetes yet.

Diabetes is a serious disease that can cause debilitating nerve pain.

Here's some helpful information:

2008 WebMD, LLC. All rights reserved.

Your pancreas makes a hormone called insulin. It's what lets your cells turn glucose from the food you eat into energy. People with type 2 diabetes make insulin, but their cells don't use it as well as they should. Doctors call this insulin resistance.

At first, the pancreas makes more insulin to try to get glucose into the cells. But eventually it can't keep up, and the sugar builds up in your blood instead.

Usually a combination of things cause type 2 diabetes, including:

Genes. Scientists have found different bits of DNA that affect how your body makes insulin.

Extra weight. Being overweight or obese can cause insulin resistance, especially if you carry your extra pounds around the middle. Now type 2 diabetes affects kids and teens as well as adults, mainly because of childhood obesity.

Metabolic syndrome. People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.

Too much glucose from your liver. When your blood sugar is low, your liver makes and sends out glucose. After you eat, your blood sugar goes up, and usually the liver will slow down and store its glucose for later. But some people's livers don't. They keep cranking out sugar.

Bad communication between cells. Sometimes cells send the wrong signals or don't pick up messages correctly. When these problems affect how your cells make and use insulin or glucose, a chain reaction can lead to diabetes.

Broken beta cells. If the cells that make the insulin send out the wrong amount of insulin at the wrong time, your blood sugar gets thrown off. High blood glucose can damage these cells, too.

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Type 2 Diabetes: Causes, Symptoms, Prevention, and More

Date: 25 Aug 2015

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Circumcision is described as a cultural, medical, and religious process which states surgical removal of the foreskin either partly or fully. Cells isolated from the circumcised tissues are referred as foreskin cells. They have been thought as feeder cell lines for embryonic stem cells. Their fibroblastic properties were also utilized for several experiments. The waste tissues that remain after the circumcision thought to have stem cell properties. Therefore, there have been very few attempts to expose their stem cell properties without turning them into induced pluripotent stem cells. Although stem cell isolation from prepuce and their mesenchymal multilineage differentiation potential have been presented many times in the literature, the current study explored hematopoietical phenotype of newborn foreskin stem cells for the first time. According to the results, human newborn foreskin stem cells (hnFSSCs) were identified by their capability to turn into all three germ layer cell types under in vitro conditions. In addition, these cells have exhibited a stable phenotype and have remained as a monolayer in vitro. hnFSSCs suggested to carry different treatment potentials for bone damages, cartilage problems, nerve damages, lesion formations, and other diseases that are derive from mesodermal, endodermal, and ectodermal origins. Owing to the location of the tissue in the body and differentiation capabilities of hnFSSCs, these cells can be considered as easily obtainable and utilizable even better than the other stem cell sources. In addition, hnFSSCs offers a great potential for tissue engineering approaches due to exhibiting embryonic stem cell-like characteristics, not having any ethical issues, and teratoma induction as in embryonic stem cell applications.

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Characterization and Differentiation of Stem Cells ...

Fat processing in centrifuge

I recently heard a news video clip about fat derived stem cell injections to the breast. There were a lot of unsubstantiated claims made, and I thought I would try to clarify some issues regarding Breast Augmentation with fat derived stem cells.

There are two types of fat injection that are being confused in this debate. The first is injection of fat itself for breast augmentation. We will call this fat injection. The second is injection of fat which is supplemented with an ultra concentrated volume of fat. This ultra concentrate sample of fat has a high concentration of stem cells. We will call this stem cell enhanced fat injection.

The American Society of Plastic Surgeons has put out a position paper regarding fat transfer. In it the issue of breast cancer detection is addressed. To quote the ASPS text:

Concern regarding the interference of autologous fat grafts with breast cancer detection is not validated by the limited number of studies available on the topic.

In other words, at this point there is no evidence that fat injection interferes with breast cancer detection. As far as complications, lumps, or irregularities the position paper states:

Studies indicate that results of fat transfer remain dependent on a surgeons technique and expertise.

In other words, when an experienced surgeon uses the correct technique, the results are good. In more than four years of injecting massive volumes of fat to the buttocks, I have yet to encounter any significant complications. I use techniques described by Sidney Coleman which have stood the test of time.

Fat injections for breast augmentation have been done carefully, systematically, and succesfully in other countries as well as in the US. As long as proper technique is used, I dont see why results would be any different than fat injection to the buttocks, which already has an established track record.

There are no new types of cells injected in a stem cell enhanced fat cell injection. The stem cells come from the same place the rest of the fat cells come from, your own fat tissue. There are normally occurring stem cells mixed with other fat cells as within the blood vessels and connective tissue of the fat.

All that we are doing is concentrating those cells so they are injected in closer proximity to each other. This likely allows for greater interaction between the stem cells themselves and the surrounding tissues, so there is stimulation for the stem cells to differentiate and create new healthy tissues.

This is not theory, it has been shown to work in breast cancer patients who have had lumpectomies followed by irradiation of tissues. I have seen the positive results in my own lumpectomy patients. These are very difficult cases which up to now were treated with complicated tissue transfers that depended on taking large pieces of tissue from other parts of the body. Clinical studies in Italy, France, and the United states have shown the efficacy of stem cell enhanced fat transfers in helping these patients.

There is a theory that stem cells themselves pose a risk to the breast by somehow turning themselves into breast cancer cells. In order to do that the stem cells would have to differentiate first into breast duct cells. The breast duct cells develop as outgrowths from the areola after a long and complex series of signals highly dependent on specific surrounding tissues. That a stem cell injected into breast would follow this highly specific series of steps is unlikely, at best. Rather, stem cells injected into connective tissue, as they are in the breast, will follow local tissue signals and differentiate ito new connective tissue. This has been demonstrated clinically.

Stem cells injected into the breast are no more likely to turn cancerous than anywhere else in the body.

There is a lot of misinformation and confusion regarding stem cell therapy, as this is a new and exciting field. The FDA is even thinking of classifying stem cell therapy as drug therapy.This would be a tremendous mistake as it would bring progress in this extremely promising field to a screeching halt.

Adult stem cells are purified from your own fat. They are not a drug. I know that I will be discussing this more.

By Dr. Ricardo L Rodriguez Board Certified Plastic Surgeon Baltimore, Maryland Ricardo L Rodriguez on Google +

Posted in Breast Fat Stem Cells

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Fat Stem Cell injections to the breast- Risky ...

The term diabetes mellitus includes several different metabolic disorders that all, if left untreated, result in abnormally high concentration of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes.

The main goal of diabetes management is, as far as possible, to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. Other goals of diabetes management are to prevent or treat the many complications that can result from the disease itself and from its treatment.

The treatment goals are related to effective control of blood glucose, blood pressure and lipids, to minimize the risk of long-term consequences associated with diabetes. They are suggested in clinical practice guidelines released by various national and international diabetes agencies.

The targets are:

Goals should be individualized based on:[3]

In older patients, clinical practice guidelines by the American Geriatrics Society states "for frail older adults, persons with life expectancy of less than 5 years, and others in whom the risks of intensive glycemic control appear to outweigh the benefits, a less stringent target such as HbA1c of 8% is appropriate".[4]

The primary issue requiring management is that of the glucose cycle. In this, glucose in the bloodstream is made available to cells in the body; a process dependent upon the twin cycles of glucose entering the bloodstream, and insulin allowing appropriate uptake into the body cells. Both aspects can require management.

The main complexities stem from the nature of the feedback loop of the glucose cycle, which is sought to be regulated:

As diabetes is a prime risk factor for cardiovascular disease, controlling other risk factors which may give rise to secondary conditions, as well as the diabetes itself, is one of the facets of diabetes management. Checking cholesterol, LDL, HDL and triglyceride levels may indicate hyperlipoproteinemia, which may warrant treatment with hypolipidemic drugs. Checking the blood pressure and keeping it within strict limits (using diet and antihypertensive treatment) protects against the retinal, renal and cardiovascular complications of diabetes. Regular follow-up by a podiatrist or other foot health specialists is encouraged to prevent the development of diabetic foot. Annual eye exams are suggested to monitor for progression of diabetic retinopathy.

Late in the 19th century, sugar in the urine (glycosuria) was associated with diabetes. Various doctors studied the connection. Frederick Madison Allen studied diabetes in 1909-12, then published a large volume, Studies Concerning Glycosuria and Diabetes, (Boston, 1913). He invented a fasting treatment for diabetes called the Allen treatment for diabetes. His diet was an early attempt at managing diabetes.

Modern approaches to diabetes primarily rely upon dietary and lifestyle management, often combined with regular ongoing blood glucose level monitoring.

Diet management allows control and awareness of the types of nutrients entering the digestive system, and hence allows indirectly, significant control over changes in blood glucose levels. Blood glucose monitoring allows verification of these, and closer control, especially important since some symptoms of diabetes are not easy for the patient to notice without actual measurement.

Other approaches include exercise and other lifestyle changes which impact the glucose cycle.

In addition, a strong partnership between the patient and the primary healthcare provider general practitioner or internist is an essential tool in the successful management of diabetes. Often the primary care doctor makes the initial diagnosis of diabetes and provides the basic tools to get the patient started on a management program. Regular appointments with the primary care physician and a certified diabetes educator are some of the best things a patient can do in the early weeks after a diagnosis of diabetes. Upon the diagnosis of diabetes, the primary care physician, specialist, or endocrinologist will conduct a full physical and medical examination. A thorough assessment covers topics such as:

Diabetes can be very complicated, and the physician needs to have as much information as possible to help the patient establish an effective management plan. Physicians may often experience data overload resulting from hundreds of blood-glucose readings, insulin dosages and other health factors occurring between regular office visits which must be deciphered during a relatively brief visit with the patient to determine patterns and establish or modify a treatment plan.[5]

The physician can also make referrals to a wide variety of professionals for additional health care support. In the UK a patient training course is available for newly diagnosed diabetics (see DESMOND). In big cities, there may be diabetes centers where several specialists, such as diabetes educators and dietitians, work together as a team. In smaller towns, the health care team may come together a little differently depending on the types of practitioners in the area. By working together, doctors and patients can optimize the healthcare team to successfully manage diabetes over the long term.

The 10 countries with the largest populations of diabetic patients are China, India, the U.S., Brazil, Russia, Mexico, Indonesia, Germany, Egypt and Japan.[6]

Blood sugar level is measured by means of a glucose meter, with the result either in mg/dL (milligrams per deciliter in the USA) or mmol/L (millimoles per litre in Canada and Europe) of blood. The average normal person should have a glucose level of around 4.5 to 7.0mmol/L (80 to 125mg/dL).

Optimal management of diabetes involves patients measuring and recording their own blood glucose levels. By keeping a diary of their own blood glucose measurements and noting the effect of food and exercise, patients can modify their lifestyle to better control their diabetes. For patients on insulin, patient involvement is important in achieving effective dosing and timing.

Some edible mushrooms are noted for the ability to lower blood sugar levels including Reishi,[7][8]Maitake[9][10][11][12][13][14]Agaricus blazei[15][16][17][18] as well as some others.

Levels which are significantly above or below this range are problematic and can in some cases be dangerous. A level of <3.8mmol/L (<70mg/dL) is usually described as a hypoglycemic attack (low blood sugar). Most diabetics know when they are going to "go hypo" and usually are able to eat some food or drink something sweet to raise levels. A patient who is hyperglycemic (high glucose) can also become temporarily hypoglycemic, under certain conditions (e.g. not eating regularly, or after strenuous exercise, followed by fatigue). Intensive efforts to achieve blood sugar levels close to normal have been shown to triple the risk of the most severe form of hypoglycemia, in which the patient requires assistance from by-standers in order to treat the episode.[19] In the United States, there were annually 48,500 hospitalizations for diabetic hypoglycemia and 13,100 for diabetic hypoglycemia resulting in coma in the period 1989 to 1991, before intensive blood sugar control was as widely recommended as today.[20] One study found that hospital admissions for diabetic hypoglycemia increased by 50% from 1990-1993 to 1997-2000, as strict blood sugar control efforts became more common.[21] Among intensively controlled type 1 diabetics, 55% of episodes of severe hypoglycemia occur during sleep, and 6% of all deaths in diabetics under the age of 40 are from nocturnal hypoglycemia in the so-called 'dead-in-bed syndrome,' while National Institute of Health statistics show that 2% to 4% of all deaths in diabetics are from hypoglycemia.[22] In children and adolescents following intensive blood sugar control, 21% of hypoglycemic episodes occurred without explanation.[23] In addition to the deaths caused by diabetic hypoglycemia, periods of severe low blood sugar can also cause permanent brain damage.[24] Interestingly, although diabetic nerve disease is usually associated with hyperglycemia, hypoglycemia as well can initiate or worsen neuropathy in diabetics intensively struggling to reduce their hyperglycemia.[25]

Levels greater than 13-15mmol/L (230270mg/dL) are considered high, and should be monitored closely to ensure that they reduce rather than continue to remain high. The patient is advised to seek urgent medical attention as soon as possible if blood sugar levels continue to rise after 2-3 tests. High blood sugar levels are known as hyperglycemia, which is not as easy to detect as hypoglycemia and usually happens over a period of days rather than hours or minutes. If left untreated, this can result in diabetic coma and death.

Prolonged and elevated levels of glucose in the blood, which is left unchecked and untreated, will, over time, result in serious diabetic complications in those susceptible and sometimes even death. There is currently no way of testing for susceptibility to complications. Diabetics are therefore recommended to check their blood sugar levels either daily or every few days. There is also diabetes management software available from blood testing manufacturers which can display results and trends over time. Type 1 diabetics normally check more often, due to insulin therapy.

A history of blood sugar level results is especially useful for the diabetic to present to their doctor or physician in the monitoring and control of the disease. Failure to maintain a strict regimen of testing can accelerate symptoms of the condition, and it is therefore imperative that any diabetic patient strictly monitor their glucose levels regularly.

Glycemic control is a medical term referring to the typical levels of blood sugar (glucose) in a person with diabetes mellitus. Much evidence suggests that many of the long-term complications of diabetes, especially the microvascular complications, result from many years of hyperglycemia (elevated levels of glucose in the blood). Good glycemic control, in the sense of a "target" for treatment, has become an important goal of diabetes care, although recent research suggests that the complications of diabetes may be caused by genetic factors[26] or, in type 1 diabetics, by the continuing effects of the autoimmune disease which first caused the pancreas to lose its insulin-producing ability.[27]

Because blood sugar levels fluctuate throughout the day and glucose records are imperfect indicators of these changes, the percentage of hemoglobin which is glycosylated is used as a proxy measure of long-term glycemic control in research trials and clinical care of people with diabetes. This test, the hemoglobin A1c or glycosylated hemoglobin reflects average glucoses over the preceding 23 months. In nondiabetic persons with normal glucose metabolism the glycosylated hemoglobin is usually 4-6% by the most common methods (normal ranges may vary by method).

"Perfect glycemic control" would mean that glucose levels were always normal (70130mg/dl, or 3.9-7.2mmol/L) and indistinguishable from a person without diabetes. In reality, because of the imperfections of treatment measures, even "good glycemic control" describes blood glucose levels that average somewhat higher than normal much of the time. In addition, one survey of type 2 diabetics found that they rated the harm to their quality of life from intensive interventions to control their blood sugar to be just as severe as the harm resulting from intermediate levels of diabetic complications.[28]

Accepted "target levels" of glucose and glycosylated hemoglobin that are considered good control have been lowered over the last 25 years, because of improvements in the tools of diabetes care, because of increasing evidence of the value of glycemic control in avoiding complications, and by the expectations of both patients and physicians. What is considered "good control" also varies by age and susceptibility of the patient to hypoglycemia.

In the 1990s the American Diabetes Association conducted a publicity campaign to persuade patients and physicians to strive for average glucose and hemoglobin A1c values below 200mg/dl (11mmol/l) and 8%. Currently many patients and physicians attempt to do better than that.

Poor glycemic control refers to persistently elevated blood glucose and glycosylated hemoglobin levels, which may range from 200500mg/dl (11-28mmol/L) and 9-15% or higher over months and years before severe complications occur. Meta-analysis of large studies done on the effects of tight vs. conventional, or more relaxed, glycemic control in type 2 diabetics have failed to demonstrate a difference in all-cause cardiovascular death, non-fatal stroke, or limb amputation, but decreased the risk of nonfatal heart attack by 15%. Additionally, tight glucose control decreased the risk of progression of retinopathy and nephropathy, and decreased the incidence peripheral neuropathy, but increased the risk of hypoglycemia 2.4 times.[29]

Relying on their own perceptions of symptoms of hyperglycemia or hypoglycemia is usually unsatisfactory as mild to moderate hyperglycemia causes no obvious symptoms in nearly all patients. Other considerations include the fact that, while food takes several hours to be digested and absorbed, insulin administration can have glucose lowering effects for as little as 2 hours or 24 hours or more (depending on the nature of the insulin preparation used and individual patient reaction). In addition, the onset and duration of the effects of oral hypoglycemic agents vary from type to type and from patient to patient.

Control and outcomes of both types 1 and 2 diabetes may be improved by patients using home glucose meters to regularly measure their glucose levels.[citation needed] Glucose monitoring is both expensive (largely due to the cost of the consumable test strips) and requires significant commitment on the part of the patient. The effort and expense may be worthwhile for patients when they use the values to sensibly adjust food, exercise, and oral medications or insulin. These adjustments are generally made by the patients themselves following training by a clinician.

Regular blood testing, especially in type 1 diabetics, is helpful to keep adequate control of glucose levels and to reduce the chance of long term side effects of the disease. There are many (at least 20+) different types of blood monitoring devices available on the market today; not every meter suits all patients and it is a specific matter of choice for the patient, in consultation with a physician or other experienced professional, to find a meter that they personally find comfortable to use. The principle of the devices is virtually the same: a small blood sample is collected and measured. In one type of meter, the electrochemical, a small blood sample is produced by the patient using a lancet (a sterile pointed needle). The blood droplet is usually collected at the bottom of a test strip, while the other end is inserted in the glucose meter. This test strip contains various chemicals so that when the blood is applied, a small electrical charge is created between two contacts. This charge will vary depending on the glucose levels within the blood. In older glucose meters, the drop of blood is placed on top of a strip. A chemical reaction occurs and the strip changes color. The meter then measures the color of the strip optically.

Self-testing is clearly important in type I diabetes where the use of insulin therapy risks episodes of hypoglycaemia and home-testing allows for adjustment of dosage on each administration.[30] However its benefit in type 2 diabetes is more controversial as there is much more variation in severity of type 2 cases.[31] It has been suggested that some type 2 patients might do as well with home urine-testing alone.[32] The best use of home blood-sugar monitoring is being researched.[33]

Benefits of control and reduced hospital admission have been reported.[34] However, patients on oral medication who do not self-adjust their drug dosage will miss many of the benefits of self-testing, and so it is questionable in this group. This is particularly so for patients taking monotherapy with metformin who are not at risk of hypoglycaemia. Regular 6 monthly laboratory testing of HbA1c (glycated haemoglobin) provides some assurance of long-term effective control and allows the adjustment of the patient's routine medication dosages in such cases. High frequency of self-testing in type 2 diabetes has not been shown to be associated with improved control.[35] The argument is made, though, that type 2 patients with poor long term control despite home blood glucose monitoring, either have not had this integrated into their overall management, or are long overdue for tighter control by a switch from oral medication to injected insulin.[36]

Continuous Glucose Monitoring (CGM) CGM technology has been rapidly developing to give people living with diabetes an idea about the speed and direction of their glucose changes. While it still requires calibration from SMBG and is not indicated for use in correction boluses, the accuracy of these monitors are increasing with every innovation.

A useful test that has usually been done in a laboratory is the measurement of blood HbA1c levels. This is the ratio of glycated hemoglobin in relation to the total hemoglobin. Persistent raised plasma glucose levels cause the proportion of these molecules to go up. This is a test that measures the average amount of diabetic control over a period originally thought to be about 3 months (the average red blood cell lifetime), but more recently[when?] thought to be more strongly weighted to the most recent 2 to 4 weeks. In the non-diabetic, the HbA1c level ranges from 4.0-6.0%; patients with diabetes mellitus who manage to keep their HbA1c level below 6.5% are considered to have good glycemic control. The HbA1c test is not appropriate if there has been changes to diet or treatment within shorter time periods than 6 weeks or there is disturbance of red cell aging (e.g. recent bleeding or hemolytic anemia) or a hemoglobinopathy (e.g. sickle cell disease). In such cases the alternative Fructosamine test is used to indicate average control in the preceding 2 to 3 weeks.

The first CGM device made available to consumers was the GlucoWatch biographer in 1999. This product is no longer sold. It was a retrospective device rather than live. Several live monitoring devices have subsequently been manufactured which provide ongoing monitoring of glucose levels on an automated basis during the day, for example:

For Type 1 diabetics there will always be a need for insulin injections throughout their life. However, both Type 1 and Type 2 diabetics can see dramatic effects on their blood sugars through controlling their diet, and some Type 2 diabetics can fully control the disease by dietary modification. As diabetes can lead to many other complications it is critical to maintain blood sugars as close to normal as possible and diet is the leading factor in this level of control.

The American Diabetes Association in 1994 recommended that 60-70% of caloric intake should be in the form of carbohydrates. This is somewhat controversial, with some researchers claiming that 40% is better,[37] while others claim benefits for a high-fiber, 75% carbohydrate diet.[38]

An article summarizing the view of the American Diabetes Association[39] gives many recommendations and references to the research. One of the conclusions is that caloric intake must be limited to that which is necessary for maintaining a healthy weight. The methodology of the dietary therapy has attracted lots of attentions from many scientific researchers and the protocols are ranging from nutritional balancing to ambulatory diet-care.[40][41][42]

Currently, one goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia. Adequate control of diabetes leads to lower risk of complications associated with unmonitored diabetes including kidney failure (requiring dialysis or transplant), blindness, heart disease and limb amputation. The most prevalent form of medication is hypoglycemic treatment through either oral hypoglycemics and/or insulin therapy. There is emerging evidence that full-blown diabetes mellitus type 2 can be evaded in those with only mildly impaired glucose tolerance.[43]

Patients with type 1 diabetes mellitus require direct injection of insulin as their bodies cannot produce enough (or even any) insulin. As of 2010, there is no other clinically available form of insulin administration other than injection for patients with type 1: injection can be done by insulin pump, by jet injector, or any of several forms of hypodermic needle. Non-injective methods of insulin administration have been unattainable as the insulin protein breaks down in the digestive tract. There are several insulin application mechanisms under experimental development as of 2004, including a capsule that passes to the liver and delivers insulin into the bloodstream.[44] There have also been proposed vaccines for type I using glutamic acid decarboxylase (GAD), but these are currently not being tested by the pharmaceutical companies that have sublicensed the patents to them.

For type 2 diabetics, diabetic management consists of a combination of diet, exercise, and weight loss, in any achievable combination depending on the patient. Obesity is very common in type 2 diabetes and contributes greatly to insulin resistance. Weight reduction and exercise improve tissue sensitivity to insulin and allow its proper use by target tissues.[45] Patients who have poor diabetic control after lifestyle modifications are typically placed on oral hypoglycemics. Some Type 2 diabetics eventually fail to respond to these and must proceed to insulin therapy. A study conducted in 2008 found that increasingly complex and costly diabetes treatments are being applied to an increasing population with type 2 diabetes. Data from 1994 to 2007 was analyzed and it was found that the mean number of diabetes medications per treated patient increased from 1.14 in 1994 to 1.63 in 2007.[46]

Patient education and compliance with treatment is very important in managing the disease. Improper use of medications and insulin can be very dangerous causing hypo- or hyper-glycemic episodes.

Insulin therapy requires close monitoring and a great deal of patient education, as improper administration is quite dangerous. For example, when food intake is reduced, less insulin is required. A previously satisfactory dosing may be too much if less food is consumed causing a hypoglycemic reaction if not intelligently adjusted. Exercise decreases insulin requirements as exercise increases glucose uptake by body cells whose glucose uptake is controlled by insulin, and vice versa. In addition, there are several types of insulin with varying times of onset and duration of action.

Insulin therapy creates risk because of the inability to continuously know a person's blood glucose level and adjust insulin infusion appropriately. New advances in technology have overcome much of this problem. Small, portable insulin infusion pumps are available from several manufacturers. They allow a continuous infusion of small amounts of insulin to be delivered through the skin around the clock, plus the ability to give bolus doses when a person eats or has elevated blood glucose levels. This is very similar to how the pancreas works, but these pumps lack a continuous "feed-back" mechanism. Thus, the user is still at risk of giving too much or too little insulin unless blood glucose measurements are made.

A further danger of insulin treatment is that while diabetic microangiopathy is usually explained as the result of hyperglycemia, studies in rats indicate that the higher than normal level of insulin diabetics inject to control their hyperglycemia may itself promote small blood vessel disease.[25] While there is no clear evidence that controlling hyperglycemia reduces diabetic macrovascular and cardiovascular disease, there are indications that intensive efforts to normalize blood glucose levels may worsen cardiovascular and cause diabetic mortality.[47]

Studies conducted in the United States[48] and Europe[49] showed that drivers with type 1 diabetes had twice as many collisions as their non-diabetic spouses, demonstrating the increased risk of driving collisions in the type 1 diabetes population. Diabetes can compromise driving safety in several ways. First, long-term complications of diabetes can interfere with the safe operation of a vehicle. For example, diabetic retinopathy (loss of peripheral vision or visual acuity), or peripheral neuropathy (loss of feeling in the feet) can impair a drivers ability to read street signs, control the speed of the vehicle, apply appropriate pressure to the brakes, etc.

Second, hypoglycemia can affect a persons thinking process, coordination, and state of consciousness.[50][51] This disruption in brain functioning is called neuroglycopenia. Studies have demonstrated that the effects of neuroglycopenia impair driving ability.[50][52] A study involving people with type 1 diabetes found that individuals reporting two or more hypoglycemia-related driving mishaps differ physiologically and behaviorally from their counterparts who report no such mishaps.[53] For example, during hypoglycemia, drivers who had two or more mishaps reported fewer warning symptoms, their driving was more impaired, and their body released less epinephrine (a hormone that helps raise BG). Additionally, individuals with a history of hypoglycemia-related driving mishaps appear to use sugar at a faster rate[54] and are relatively slower at processing information.[55] These findings indicate that although anyone with type 1 diabetes may be at some risk of experiencing disruptive hypoglycemia while driving, there is a subgroup of type 1 drivers who are more vulnerable to such events.

Given the above research findings, it is recommended that drivers with type 1 diabetes with a history of driving mishaps should never drive when their BG is less than 70mg/dl (3.9mmol/l). Instead, these drivers are advised to treat hypoglycemia and delay driving until their BG is above 90mg/dl (5mmol/l).[53] Such drivers should also learn as much as possible about what causes their hypoglycemia, and use this information to avoid future hypoglycemia while driving.

Studies funded by the National Institutes of Health (NIH) have demonstrated that face-to-face training programs designed to help individuals with type 1 diabetes better anticipate, detect, and prevent extreme BG can reduce the occurrence of future hypoglycemia-related driving mishaps.[56][57][58] An internet-version of this training has also been shown to have significant beneficial results.[59] Additional NIH funded research to develop internet interventions specifically to help improve driving safety in drivers with type 1 diabetes is currently underway.[60]

The U.S. Food and Drug Administration (FDA) has approved a treatment called Exenatide, based on the saliva of a Gila monster, to control blood sugar in patients with type 2 diabetes.

Artificial Intelligence researcher Dr. Cynthia Marling, of the Ohio University Russ College of Engineering and Technology, in collaboration with the Appalachian Rural Health Institute Diabetes Center, is developing a case based reasoning system to aid in diabetes management. The goal of the project is to provide automated intelligent decision support to diabetes patients and their professional care providers by interpreting the ever increasing quantities of data provided by current diabetes management technology and translating it into better care without time consuming manual effort on the part of an endocrinologist or diabetologist.[61] This type of Artificial Intelligence-based treatment shows some promise with initial testing of a prototype system producing best practice treatment advice which anaylizing physicians deemed to have some degree of benefit over 70% of the time and advice of neutral benefit another nearly 25% of the time.[5]

Use of a "Diabetes Coach" is becoming an increasingly popular way to manage diabetes. A Diabetes Coach is usually a Certified diabetes educator (CDE) who is trained to help people in all aspects of caring for their diabetes. The CDE can advise the patient on diet, medications, proper use of insulin injections and pumps, exercise, and other ways to manage diabetes while living a healthy and active lifestyle. CDEs can be found locally or by contacting a company which provides personalized diabetes care using CDEs. Diabetes Coaches can speak to a patient on a pay-per-call basis or via a monthly plan.

High blood glucose in diabetic people is a risk factor for developing gum and teeth problems, especially in post puberty and aging individuals. Diabetic patients have greater chances of developing oral health problems such as tooth decay, salivary gland dysfunction, fungal infections, inflammatory skin disease, periodontal disease or taste impairment and thrush of the mouth.[62] The oral problems in persons suffering from diabetes can be prevented with a good control of the blood sugar levels, regular check-ups and a very good oral hygiene. By maintaining a good oral status, diabetic persons prevent losing their teeth as a result of various periodontal conditions.

Diabetic persons must increase their awareness towards the oral infections as they have a double impact on one's health. Firstly, people with diabetes are more likely to develop periodontal disease which causes increased blood sugar levels, often leading to diabetes complications. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications.[63]

The first symptoms of gum and teeth infections in diabetic persons are decreased salivary flow, burning mouth or tongue. Also, patients may experience signs as dry mouth which increases the incidence of decay. Poorly controlled diabetes usually leads to gum problems recession as plaque creates more harmful proteins in the gums.

Tooth decay and cavities are some of the first oral problems that individuals with diabetes are at risk for. Increased blood sugar levels translate into greater sugars and acids that attack the teeth and lead to gum diseases. Gingivitis can also occur as a result of increased blood sugar levels along with an inappropriate oral hygiene. Periodontitis is an oral disease caused by untreated gingivitis and which destroys the soft tissue and bone that support the teeth. This disease may cause the gums to pull away from the teeth which may eventually loosen and fall out. Diabetic people tend to experience more severe periodontitis because diabetes lowers the ability to resist infection[64] and also slows healing. At the same time, an oral infection such as periodontitis can make diabetes more difficult to control because it causes the blood sugar levels to rise.[65]

To prevent further diabetic complications as well as serious oral problems, diabetic persons must keep their blood sugar levels under control and have a proper oral hygiene. A study in the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.[63] At the same time, diabetic patients are recommended to have regular checkups with a dental care provider at least once in three to four months. Diabetics who receive good dental care and have good insulin control typically have a better chance at avoiding gum disease to help prevent tooth loss.[66]

Dental care is therefore even more important for diabetic patients than for healthy individuals. Maintaining the teeth and gum healthy is done by taking some preventing measures such as regular appointments at a dentist and a very good oral hygiene. Also, oral health problems can be avoided by closely monitoring the blood sugar levels. Patients who keep better under control their blood sugar levels and diabetes are less likely to develop oral health problems when compared to diabetic patients who control their disease moderately or poorly.

Poor oral hygiene is a great factor to take under consideration when it comes to oral problems and even more in people with diabetes. Diabetic people are advised to brush their teeth at least twice a day, and if possible, after all meals and snacks. However, brushing in the morning and at night is mandatory as well as flossing and using an anti-bacterial mouthwash. Individuals who suffer from diabetes are recommended to use toothpaste that contains fluoride as this has proved to be the most efficient in fighting oral infections and tooth decay. Flossing must be done at least once a day, as well because it is helpful in preventing oral problems by removing the plaque between the teeth, which is not removed when brushing.

Diabetic patients must get professional dental cleanings every six months. In cases when dental surgery is needed, it is necessary to take some special precautions such as adjusting diabetes medication or taking antibiotics to prevent infection. Looking for early signs of gum disease (redness, swelling, bleeding gums) and informing the dentist about them is also helpful in preventing further complications. Quitting smoking is recommended to avoid serious diabetes complications and oral diseases.

Diabetic persons are advised to make morning appointments to the dental care provider as during this time of the day the blood sugar levels tend to be better kept under control. Not least, individuals who suffer from diabetes must make sure both their physician and dental care provider are informed and aware of their condition, medical history and periodontal status.

Because many patients with diabetes have two or more comorbidities, they often require multiple medications. The prevalence of medication nonadherence is high among patients with chronic conditions, such as diabetes, and nonadherence is associated with public health issues and higher health care costs. One reason for nonadherence is the cost of medications. Being able to detect cost-related nonadherence is important for health care professionals, because this can lead to strategies to assist patients with problems paying for their medications. Some of these strategies are use of generic drugs or therapeutic alternatives, substituting a prescription drug with an over-the-counter medication, and pill-splitting. Interventions to improve adherence can achieve reductions in diabetes morbidity and mortality, as well as significant cost savings to the health care system.[67]

Diabetes type1 is caused by the destruction of enough beta cells to produce symptoms; these cells, which are found in the Islets of Langerhans in the pancreas, produce and secrete insulin, the single hormone responsible for allowing glucose to enter from the blood into cells (in addition to the hormone amylin, another hormone required for glucose homeostasis). Hence, the phrase "curing diabetes type1" means "causing a maintenance or restoration of the endogenous ability of the body to produce insulin in response to the level of blood glucose" and cooperative operation with counterregulatory hormones.

This section deals only with approaches for curing the underlying condition of diabetes type1, by enabling the body to endogenously, in vivo, produce insulin in response to the level of blood glucose. It does not cover other approaches, such as, for instance, closed-loop integrated glucometer/insulin pump products, which could potentially increase the quality-of-life for some who have diabetes type1, and may by some be termed "artificial pancreas".

A biological approach to the artificial pancreas is to implant bioengineered tissue containing islet cells, which would secrete the amounts of insulin, amylin and glucagon needed in response to sensed glucose.

When islet cells have been transplanted via the Edmonton protocol, insulin production (and glycemic control) was restored, but at the expense of continued immunosuppression drugs. Encapsulation of the islet cells in a protective coating has been developed to block the immune response to transplanted cells, which relieves the burden of immunosuppression and benefits the longevity of the transplant.[68]

Research is being done at several locations in which islet cells are developed from stem cells.

Stem cell research has also been suggested as a potential avenue for a cure since it may permit regrowth of Islet cells which are genetically part of the treated individual, thus perhaps eliminating the need for immuno-suppressants.[48] This new method autologous nonmyeloablative hematopoietic stem cell transplantation was developed by a research team composed by Brazilian and American scientists (Dr. Julio Voltarelli, Dr. Carlos Eduardo Couri, Dr Richard Burt, and colleagues) and it was the first study to use stem cell therapy in human diabetes mellitus This was initially tested in mice and in 2007 there was the first publication of stem cell therapy to treat this form of diabetes.[69] Until 2009, there was 23 patients included and followed for a mean period of 29.8 months (ranging from 7 to 58 months). In the trial, severe immunosuppression with high doses of cyclophosphamide and anti-thymocyte globulin is used with the aim of "turning off" the immunologic system", and then autologous hematopoietic stem cells are reinfused to regenerate a new one. In summary it is a kind of "immunologic reset" that blocks the autoimmune attack against residual pancreatic insulin-producing cells. Until December 2009, 12 patients remained continuously insulin-free for periods ranging from 14 to 52 months and 8 patients became transiently insulin-free for periods ranging from 6 to 47 months. Of these last 8 patients, 2 became insulin-free again after the use of sitagliptin, a DPP-4 inhibitor approved only to treat type 2 diabetic patients and this is also the first study to document the use and complete insulin-independendce in humans with type 1 diabetes with this medication. In parallel with insulin suspension, indirect measures of endogenous insulin secretion revealed that it significantly increased in the whole group of patients, regardless the need of daily exogenous insulin use.[70]

Technology for gene therapy is advancing rapidly such that there are multiple pathways possible to support endocrine function, with potential to practically cure diabetes.[71]

Type2 diabetes is usually first treated by increasing physical activity, and eliminating saturated fat and reducing sugar and carbohydrate intake with a goal of losing weight. These can restore insulin sensitivity even when the weight loss is modest, for example around 5kg (10 to 15lb), most especially when it is in abdominal fat deposits. Diets that are very low in saturated fats have been claimed to reverse insulin resistance.[75][76]

Testosterone replacement therapy may improve glucose tolerance and insulin sensitivity in diabetic hypogonadal men. The mechanisms by which testosterone decreases insulin resistance is under study.[77] Moreover, testosterone may have a protective effect on pancreatic beta cells, which is possibly exerted by androgen-receptor-mediated mechanisms and influence of inflammatory cytokines.[78]

Recently[when?] it has been suggested that a type of gastric bypass surgery may normalize blood glucose levels in 80-100% of severely obese patients with diabetes. The precise causal mechanisms are being intensively researched; its results may not simply be attributable to weight loss, as the improvement in blood sugars seems to precede any change in body mass. This approach may become a treatment for some people with type2 diabetes, but has not yet been studied in prospective clinical trials.[79] This surgery may have the additional benefit of reducing the death rate from all causes by up to 40% in severely obese people.[80] A small number of normal to moderately obese patients with type2 diabetes have successfully undergone similar operations.[81][82]

MODY is another classification of diabetes and it can be treated by early lifesyle management and medical management. it has to be treated in the early stage, so as to provide a good health.

Excerpt from:
Diabetes management - Wikipedia, the free encyclopedia

If you have been diagnosed with chronic kidney diseaseor have a family member or friend who hasyou probably have a lot of questions. What does it mean to have chronic kidney disease? How will it impact my health and my life? Will I need dialysis? What do I do now? We hope this site will provide some answers.

Kidney disease means that the kidneys are damaged and can't filter blood like they should. This damage can cause wastes to build up in the body. It can also cause other problems that can harm your health.

For most people, kidney damage occurs slowly over many years, often due to diabetes or high blood pressure. This is called chronic kidney disease. When someone has a sudden change in kidney functionbecause of illness, injury, or have taken certain medicationsthis is called acute kidney injury. This can occur in a person with normal kidneys or in someone who already has kidney problems.

People with kidney disease often have high blood pressure, and are more likely to have a stroke or heart attack. They can also develop anemia (low number of red blood cells), bone disease, and malnutrition. Kidney disease can get worse over time, and may lead to kidney failure. Learn about what your kidneys do.

Diabetes and high blood pressure are the most common causes of kidney disease. Other important causes include glomerulonephritis and polycystic kidney disease. Your provider will want to know why you have kidney disease so your treatment can also address the cause.

Treatment may help slow kidney disease and keep the kidneys healthier longer. Find out about medicines and diet and lifestyle changes that are important for people with kidney disease.

Take these steps to help keep your kidneys healthier longer:

Work with your health care team to figure out the treatment plan that makes the most sense for you. With proper management, you may never need dialysis or, at least, not for a very long time.

NIDDK conducts and supports research to improve the detection of kidney disease, as well as treatment for those with kidney disease and kidney failure. For example, the Chronic Renal Insufficiency Cohort (CRIC) Study, an NIDDK-funded study started in 2001, is working to better understand kidney disease and its link to heart disease. NIDDK also supports many clinical trials, which are research studies to determine how well a treatment works. To learn more about eligibility and how to get involved in a clinical trial, visit http://www.clinicaltrial.gov.

Your GFR and urine albumin results will help you and your provider keep track of your kidney health.

Treating kidney disease includes making changes to your diet and to other lifestyle choices.

Medicines may slow down kidney disease.

Your health care team may include your primary care provider, as well as a dietitian, a nephrologist, and others.

It's important to understand kidney failure treatment options and know the steps you can take early on to prepare for treatment if you need it.

Find Frequently Asked Questions for people with kidney disease.

Page last updated: September 17, 2014

Originally posted here:
Living with - National Kidney Disease Education Program

High blood pressure and kidney disease facts

*High blood pressure and kidney disease facts medically edited by: Charles Patrick Davis, MD, PhD

The kidneys play a key role in keeping a person's blood pressure in a healthy range, and blood pressure, in turn, can affect the health of the kidneys. High blood pressure, also called hypertension, can damage the kidneys and lead to chronic kidney disease (CKD).

Blood pressure measures the force of blood against the walls of the blood vessels. Extra fluid in the body increases the amount of fluid in blood vessels and makes blood pressure higher. Narrow, stiff, or clogged blood vessels also raise blood pressure.

People with high blood pressure should see their doctor regularly.

Medically Reviewed by a Doctor on 3/31/2014

Kidney Disease (HBP Related) - Symptoms Question: What were the symptoms of your kidney disease?

Hypertensive Kidney Disease - Experiences Question: Please share your experiences of hypertensive kidney disease.

Hypertensive Kidney Disease - Hypertension Symptoms Question: What symptoms of hypertension did you experience with hypertensive kidney disease?

Hypertensive Kidney Disease - Medications Question: What medications have been effective for treating hypertensive kidney disease?

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High Blood Pressure Related Kidney Disease: Get Answers

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Many Americans know nothing about kidney diseaseuntil it's too late.

"Unlike many diseases, kidney disease often has no symptoms until it is very advanced," says Andrew Narva, M.D., Director of the National Kidney Disease Education Program (NKDEP) a part of the NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

"For this reason and others, it is important for people to not only become aware of their risk, but also to learn about the steps they can take to keep their kidneys healthier longer. An important step is to get tested."

That testing is even more important for populations that are at higher risk for kidney disease, such as African Americans, adds Dr. Narva.

Your doctor can do very simple tests to check for kidney disease:

How can you tell if you are at risk for kidney disease? Ask yourself these questions:

If you answered "yes" to any of these questions, you are at risk for kidney disease. Now is the time to get tested.

Your health care provider will order two simple tests to check your kidneysa blood test to check your glomerular filtration rate (GFR) and a urine test to check for protein.

Kidney disease is usually a progressive disease, which means that the damage in the kidneys tends to be permanent and can't be undone. So it is important to identify kidney disease early before the damage is done. The good news is that kidney disease can be treated very effectively if it is caught in the early stages. This is very important, since kidney disease also makes your risks for heart disease and stroke higher.

For people who have diabetes, monitoring blood glucose levels is very important. Your health care provider can help you find the right device for doing this if you are diagnosed with diabetes.

Controlling blood pressure is also very important for people with kidney disease. There are several types of medicine that help people keep their blood pressure in a healthy range. Two kinds of medicines, ACEi (angiotensin converting enzyme inhibitors) and ARBs (angiotensin receptor blockers) also help to protect the kidneys.

If one or both kidneys fail completely and the damage can't be reversed, the condition is called kidney failure or end-stage renal disease (ESRD). When this occurs, your kidneys can no longer filter wastes well enough to keep you healthy. The symptoms for ESRD include fatigue, weakness, nausea, vomiting, and itching.

Treatments for kidney failure include dialysis or transplantation. There are two major types of dialysis:

A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, and you no longer need dialysis.

Many researchers are studying kidney disease. They are looking for ways to improve diagnosis, make treatments more effective, and make dialysis and transplantation work better. Several areas of research supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) hold great potential.

NIDDK is sponsoring a major studythe Chronic Renal Insufficiency Cohort (CRIC) studyto learn more about how kidney disease progresses. CRIC is following 3,000 adults for seven years. All study participants have mild to moderate kidney disease, and about half have diabetes.

Researchers think that some CRIC study participants' kidney function will decline more rapidly than others', and that some will develop cardiovascular disease while others won't. The goal of the study is to identify the factors linked to rapid decline of kidney function and development of cardiovascular disease.

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Kidney Disease: Early Detection and Treatment