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Lancet 08/16/2019 10:13
Last week in a controversial move, India revoked the autonomous status of Jammu and Kashmir, allowing India greater authority over the state's affairs. The announcement fanned tension with Pakistan, which also claims the region and has fought India over it for more than seven decades. At least 28 000 Indian security forces have been deployed; in the capital city Srinagar, a lockdown has been implemented that suspended communication and internet links, and a strict curfew has been imposed. The militant presence raises serious concerns for the health, safety, and freedoms of the Kashmiri people.
Lancet 08/16/2019 07:13
Before risankizumab's introduction, there were ten biologic therapies approved for psoriasis, with two more in development. Do we really need all of these expensive therapies for this disease? A close look at the data shows that we do not have any treatments that reliably achieve complete clearing as evidenced by psoriasis area and severity index (PASI) 100, and only the newest treatments achieve PASI 90 in high proportions of patients. Moreover, many treatments require frequent injections or are less effective in patients who have not had success with other therapies.
Lancet 08/16/2019 06:13
Planet Earth is heating up, with heatwaves increasing in frequency, intensity, and duration.1 In 2019, so far, all-time high temperature records have been toppled in multiple countries. An early and intense heatwave in Europe made June the hottest month on record for the continent with the average temperature 2°C above normal.2 France reported a new national temperature record of 45·9°C on June 28. On July 24–25, a second major heatwave in a month set new all-time highs on 2 consecutive days in Germany, Belgium, and the Netherlands.
Lancet 08/16/2019 05:14
In the space of a few months in 1921, an acute and terminal disease—type 1 diabetes—became a manageable chronic condition. The discovery of insulin by Frederick Banting, Charles Best, and their colleagues captured a mood of therapeutic optimism, the hope that a new scientific medicine, rooted in the laboratory and working through the networks of industry and state health care, could find cures for all diseases. But insulin therapy, clinicians soon realised, was effective in only a minority of patients.
Lancet 08/16/2019 00:13
“For those who have nothing, a little is a lot.”1 As Sterling Bunnell, a pioneer of tetraplegic extremity reconstruction observed, small gains in function for people with spinal cord injury can equate to enormous gains in independence. People with mid-cervical spinal cord injury usually retain volitional movement at the shoulder and some control of their elbows and wrists. Hand opening and closing, a capacity that patients rate as more important to regain than walking or sexual function, is often lost.
Lancet 08/15/2019 23:13
Since the fall of former Sudan President Omar al-Bashir's regime in April, 2019, the political and security situation in Sudan has been in flux. The Sudanese Transitional Military Council (TMC) and opposition groups signed a 3-year power-sharing agreement on July 4, 2019. Protesters have since voiced a mix of cautious optimism and scepticism, particularly about the role of the military in the transitional period.1 This is because until June 30, 2019, the TMC had violently responded to peaceful mass protests organised by the Forces for Freedom and Change (FFC), an umbrella organisation of opposition groups, prominently spearheaded by multiple medical professional bodies.
Lancet 08/15/2019 22:13
World Humanitarian Day, which takes place on Aug 19 each year, celebrates the efforts of humanitarian aid workers operating in war-torn, resource deprived, or disease-affected settings to sustain human life. This year, special tribute is paid to the unsung heroes of humanitarian health—women. Whether they are at the forefront of an international crisis or operating within local communities, their long-lasting and stabilising impact makes them true peace keepers of humanitarian health.
Lancet 08/15/2019 21:13
The notion that more data are more informative has helped lay the foundation for a new era in medical diagnostics. But this “kitchen sink” approach can be misguided. A classic example is a middle-aged executive without any symptoms who undergoes a yearly health check that sets off a cascade of additional testing, sometimes invasive and not without risk but often without any benefit except for the creation of revenue. That example precedes today's data collection technologies of whole genome sequencing (WGS), wearable biosensors, high-resolution imaging, gut microbiome metagenomics, and more.
Lancet 08/15/2019 19:13
We read the Article by Matthew Wilson and colleagues1 with interest. Their study findings add weight to the argument that remifentanil is an increasingly preferable pharmacological alternative to pethidine for labour analgesia and that it reduces conversion rates to epidural analgesia. However, the investigators have overlooked the substantial staffing implications that the widespread adoption of remifentanil would have on maternity units.
Lancet 08/15/2019 19:13
I read with interest the World Report by Marta Paterlini1 about the shortfall of doctors in Italy. I commend Paterlini for highlighting this unsolved problem, but unfortunately, the piece fails to identify its real cause. Born, raised, and trained as an anaesthesiologist in Italy, then re-trained in the USA, I have had the privilege of living and working in different countries, and in my opinion, this issue is far from being addressed in a thorough and systematic way.
Lancet 08/15/2019 19:13
Family health history (FHH) is the most useful means of assessing risk for common chronic diseases. The odds ratio for risk of developing disease with a positive FHH is frequently greater than 2, and actions can be taken to mitigate risk by adhering to screening guidelines, genetic counselling, genetic risk testing, and other screening methods. Challenges to the routine acquisition of FHH include constraints on provider time to collect data and the difficulty in accessing risk calculators. Disease-specific and broader risk assessment software platforms have been developed, many with clinical decision support and informatics interoperability, but few access patient information directly.

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