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Lancet 01/17/2020 15:16
On a morning in a colder than average winter in Salem, Missouri, USA, a stranger approached my husband and said, “I guess this cold snap blows that global warming theory out of the water.” Salem is a town of about 5000 people, the county seat of Dent County. Most of the county's residents are white. More than 80% of voters chose Donald Trump for US President. When my husband hopped out of his VW camper with his full white beard and a baseball cap that read Powell's Books, he looked like what he is: a philosophy professor from the University of Missouri on his way to fish the Current River.
Lancet 01/17/2020 10:17
Cataract surgery is one of the most commonly performed operations. Lasers are used for many applications in ophthalmology; however, their use in cataract surgery is fairly recent. On introduction to clinical practice, laser cataract surgery platforms were marketed as bringing a stepwise improvement in surgical technique and were used as a differentiating factor between many cataract surgery providers. The surgical steps automated in femtosecond laser-assisted cataract surgery (FLACS) are corneal incisions, opening of the crystalline lens capsule (capsulotomy), and crystalline lens fragmentation, with less phacoemulsification (ultrasound) energy subsequently needed to complete lens removal.
Lancet 01/17/2020 08:17
28 people dead and rising, tens of thousands forced from their homes, Indigenous communities displaced, up to 1 billion animals dead, and some of the world's most beautiful and unique natural landscapes burned. The sheer scale of Australia's bushfires is hard to comprehend.
Lancet 01/17/2020 05:18
43% of US households report that at least one family member has a pre-existing medical condition, according to a survey released by Gallup on Dec 6, 2019. 49% of Americans (156 million people) receive health insurance through employers, and before the 2010 Affordable Care Act (ACA), a change of situation, such as losing or switching a job, would have allowed insurance companies to decline coverage or potentially make people uninsurable because of chronic health conditions. Although Democrats and Republicans both argue that they support the ACA ban on pre-existing condition denials, in power, Republicans have actively (but so far unsuccessfully) worked to repeal the ACA without providing an alternative.
Lancet 01/17/2020 02:16
For the past two decades, attention to sepsis has intensified because of growing recognition that it is one of the most common and lethal conditions we face, whether as a patient, provider, hospital, or public health agency. Until now, we have had an incomplete accounting of the global epidemiology of sepsis, with several reports from high-income countries and relatively few from countries of low and middle income (LMICs). In The Lancet, Kristina Rudd and colleagues1 present an analysis of data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, which is the most comprehensive assessment of the worldwide sepsis burden to date.
Lancet 01/17/2020 01:17
The fabric of humanity is unravelling. That is not a 21st-century diagnosis of our collective ills. It was the conclusion drawn by Lucretius, a Roman poet whose epic De Rerum Natura (The Nature of Things) was published in the first century BCE. Divided into six books, Lucretius described the “architects of Death” as Disease and Pain. But he rooted his analysis of human life in the wider predicaments facing his society—“our land in her hour of need”. Lucretius linked prospects for the human condition to the state of Nature and the Earth, to the natural and physical systems on which human existence depended.
Lancet 01/17/2020 00:17
If there is one thing that medical school rightly instils, it's a particular strain of twitchy hypervigilance. New doctors emerge impregnated with dread at the thought of missing those time-critical diagnoses that, unless dealt with this instant, might maim or claim the lives of our patients. Meningococcal sepsis, necrotising fasciitis, aortic dissection, temporal arteritis: on setting out on the wards, diagnoses like these made me quake. Losing a patient's life or independence through diagnostic ineptitude? Nothing, I believed, could be worse than being that doctor.
Lancet 01/16/2020 23:15
It wasn't until the 19th century that diseases of the kidney began to be recognised under the eponymous diagnosis of Bright's disease, named after the father of nephrology Richard Bright (1789–1858). While our understanding of various types of kidney injury and pathologies has broadened over time, the complexities and clinical overlap of kidney diseases have led to less than adequate prevention and treatment strategies. Chronic kidney disease is present in about 10% of the world's population—more than diabetes and cancer combined—ranks as the ninth leading cause of death in the USA, and accounts for billions of dollars in medical costs, suffering, and lost quality life-years.
Lancet 01/16/2020 21:16
The power-sharing agreement between Sudan's military and opposition groups signed in July, 2019, marked the end of nearly three decades of military dictatorship, and brought genuine hope of a lasting peace. As of January, 2020, negotiations continue between the transitional government and rebel groups, and the path towards permanent civilian rule is uncertain. Meanwhile, the country faces escalating humanitarian catastrophe, with 7·8 million people facing critical problems related to mental and physical wellbeing, including 1·6 million internally displaced people and 1·1 million refugees.
Lancet 01/16/2020 20:16
This year, we launched the Wakley–Wu Lien Teh Prize1 to give a voice to Chinese doctors to speak up about their own stories and concerns in medical practice, and we were delighted to receive around 130 submissions. Two editors at The Lancet Group shortlisted 12 essays, which were sent anonymously to a voting panel at Peking University People's Hospital, Beijing, China, and a Lancet author, Peng Gong, professor at Tsinghua University, Beijing, China.
Lancet 01/16/2020 19:17
Brian Rini and colleagues1 reported the results of IMmotion151, a randomised controlled trial in patients with advanced renal cell carcinoma. This study met its coprimary endpoint in patients whose disease expressed programmed death ligand 1, by showing an increased median progression-free survival for atezolizumab plus bevacizumab (11·2 months; IQR 8·9–15·0) compared with sunitinib (7·7 months; IQR 6·8–9·7; hazard ratio 0·74 [95% CI 0·57–0·96]; p=0·022). The authors conclude that this study supports atezolizumab plus bevacizumab as a first-line treatment for selected patients.
Lancet 01/16/2020 19:17
The UN General Assembly launched the Sustainable Development Goals (SDGs) in September, 2015.1 The original global SDG framework included 17 goals, 169 targets, and 232 unique indicators.2 Of these, 12 goals, 33 targets, and 57 indicators have been identified as health-related SDGs (HRSDGs),3–6 that is, pertaining to health outcomes, health services, and well-established environmental, occupational, behavioural, and metabolic risks.
Lancet 01/16/2020 19:17
From the discoveries of Fleming and Lister to the more recent work on aromatase inhibitors done by the Royal Marsden Hospital and Institute for Cancer Research, research and health care have had a long and illustrious relationship in the UK. This relationship resulted in many discoveries and innovations that have benefited patients worldwide, and it is also clear that patients have better outcomes when they are managed in research-active settings. However, this symbiotic relationship is under threat, from both an increasing divergence of academia and the National Health Service (NHS), and a worsening research culture.
Lancet 01/16/2020 19:17
Antibiotic prophylaxis is not recommended for operative vaginal birth because of insufficient evidence of the effectiveness in protecting against maternal infection. Marian Knight and colleagues1 show benefits from a single post-delivery antibiotic dose on maternal infection rates. However, this well designed and well conducted controlled trial has some important limitations. First, the trial includes short-term follow-up only. Second, a possible bias might arise due to a high (24%) loss of participants to follow-up (although blinding or masking reduces bias).
Lancet 01/16/2020 19:17
In their Series paper, Marco Peres and colleagues1 reproduce a map of the estimated global prevalence of untreated dental caries in permanent teeth for 2017. France is reported to be one of the five countries in the world where prevalence is higher than 50%. This prevalence seems surprisingly high for a country where the public health insurance system leaves routine dental treatments (examinations, extractions, restorations, and endodontic treatments) with no out-of-pocket charges for more than 95% of the population.
Lancet 01/16/2020 19:17
When children in Ratodero, a small town in the Sindh province of Pakistan, suddenly became ill in the early months of 2019, HIV was not a cause anyone would have suspected. Unlike many other infectious diseases in Pakistan, HIV prevalence, especially in children, has been relatively low.1 However, in April, 2019, local journalists reported that the children were indeed infected with HIV. Further investigations revealed that many of the children were being cared for by a self-proclaimed, low-cost paediatrician (whose qualifications have not been established) who had been reusing needles and telling patients that they were too poor to afford new needles.

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