EPIDEMIOLOGY OF WHIPLASH ASSOCIATED DISORDERS

EPIDEMIOLOGY OF WHIPLASH ASSOCIATED DISORDERS

The term whiplash injury has been used since the late 1920s, when H.E. Crowe coined the term at a medical meeting in San Francisco. It was originally described as an injury mechanism to the neck, but was later also used to define the actual symptoms after such an event. The first known case report was published in the Journal of the American Medical Association in 1953, when Gay and Abbot described 50 patients who had been exposed to whiplash mechanism in car collisions. It was reported that the majority had been exposed to rear-end collisions and that the majority were also examined between one and 24 months after the collision, thus representing a mix of patients with acute or persistent symptoms. Cervical pain with radiation into the occipital region of the skull, shoulder girdle or upper extremities were reported as common symptoms, but irritability, poor concentration and subjective vertigo were also described.

People who are exposed to energy transfer to the neck, in sports, falls or other mishaps, may also experience cervical pain. After such events, however, it is less common that the injury is labeled “whiplash”, but instead other terms, such as neck strain, neck sprain or simply neck injury, are used. The term whiplash associateddisorder (WAD) was introduced in 1995 by the Quebec Task Force (QTF), who published the first systematic review on whiplash injuries. The term was intended to reflect that whiplash is an injury mechanism, and the consequences of the mechanism were the spectrum of symptoms (disorders). The QTF formulated the following conceptual definition:

               Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from rear-end or side-impact motor vehicle collisions, but can also occur during diving or other mishaps. The impact may result in bony or soft-tissue injuries (whiplash injury) which in turn may lead to a variety of clinical manifestations (whiplash-associated disorders).

The reason for excluding frontal collisions from the definition is not discussed in the report and is likely to be an error, since it is known that 25-30% of whiplash injury occurs in such impact direction.

The QTF also suggested a classification of WAD into five categories based on clinical signs and symptoms. This classification is mostly used to classify WAD in the acute phase.

Since the publication of the QTF findings, the term WAD has been increasingly used in the medical literature, and it is also a frequently used term in insurance medicine.

Biomechanics Definition

Biomechanics Definition

              

            Biomechanics, as related to motor vehicle collisions, is a study that applies to the examination of internal and external mechanical forces acting on a biological system (human) during a crash event(s), and the effects that these forces have on the occupant. This expert is used to tie in the accident reconstruction aspects of the case to the physician’s diagnosis. The majority of the biomechanists lack the training or license to make any formal diagnosis of a medical condition and, therefore, there are many cases where the courts have not allowed biomechanists to give opinions about a diagnosis. In order to make a diagnosis, one would need to be a (MD/DC) physician.

               In the “biologic” portion of field of biomechanics in relation to its use in car crash biomechanics, the expert is knowledgeable in several areas. As the biological system for the human is diverse and the anatomical considerations are complex, the biomechanics expert should have specific training or taken courses in:

               A) formal courses in human anatomy. A cadaver class is essential to see real tissue.  

               B) functional anatomy courses, that is, what happens to anatomical structures within the human frame when they move through the various stages of motion in a specific crash. Kinesiology is an excellent college program to learn how to photograph a human that has marked joints and analyze each joint through the various stages of motion during movement. This study would require knowledge of what muscles are active in various motions and the roles of ligaments and muscles/tendons in motion events.

               C) training in what human factors make a person more prone or less susceptible to injury events.

               D) clinical experience observing occupants (human test subjects) or dummies in various impacts.

               E) it would bolster the credibility of the expert to have some real-world experience as an Emergency Medical Technician or paramedic so that actual cases could be analyzed at the scene of the crash to provide more expertise.

               In the mechanical portion of biomechanics relative to MVCs, the expert should have adequate knowledge and training in the following areas:

               A) significance of calculated delta-V of the occupant’s vehicle from the reconstructionist.

               B) collision dynamics from the reconstructionist and other documents so the angle of impacts (direction of impact) and how body would move in the collision relative to these directions could be determined.

               C) duration of impact and the importance of time in injury causation; also how impact types, the primary direction of force (PDOF), and vehicle motion during time and after collision affect time elements.

               D) photographic analysis of occupants within vehicle or use of exemplar vehicle initial position relative to the interior of the vehicle and the striking vehicle. Not always possible, but should be requested. There is little credibility for any biomechanics expert opinion that has not formally requested to inspect the injured party (plaintiff) in the vehicle or an exemplar vehicle. The lack of a request could imply a typical approach of taking a “one-size-fits-all” type of business. There are circumstances where this photographic evaluation is not possible or practical.

               Who are these biomechanics experts who testify about MVC injuries? Biomechanics experts in MVCs have a wide variety of formal degrees and/or training, including mechanical engineering, physics, kinesiology, mathematics, biomedical engineering, biomechanics, and physicians (medical doctors and doctors of chiropractic). Some traffic accident reconstructionists with no formal degrees from any college will attempt to qualify in trails as experts in the field of biomechanics. The field of biomechanics is very broad numerous specializations. Prior to the mid-1980s most universities offered biomechanics degrees in America under kinesiology programs within their physical education departments, where athletes could be analyzed for motion studies, mechanical forces, and anatomic considerations. Kinesiology is a science that encompasses the area of biomechanics and is the study of human movement. Kinematics is the appearance or description of motion. Kinetics is the study of the actions of forces. Dynamics is the study of systems subject to positive or negative acceleration.

How do occupants sit in vehicles relative to occupant space?

How do occupants sit in vehicles relative to occupant space?

People sit differently in car seats, in part due to personal preferences, habit, body profile, car interior dimensions, seating angle, and other factors. All one has to do is simply look at other drivers on the road to realize that there is a vast amount of differences in the way people sit in vehicles--even in similar types of vehicle--or observe how people sit at home and work. Some prefer the seat to be vertical while others like to recline the seat. Others like to sit straight while others lean sideways. Some people constantly move around in their vehicle, seldom maintaining a stationary posture, while others look like they are made out of stone and rarely move about. Gender has been shown to be a significant factor in seating positioning. Cullen et al evaluated 2.935 cars in the U.K. and U.S. to see how adults sit in their vehicles. The 5^th percentile female sat 24 cm (9.45 in) closer in the U.K. study and 32 cm (12.6 in) closer in the U.S. study, when measuring the distance between the nasion and the steering wheel, than the 95^th percentile male occupant. Drivers sat closer to the dash than passengers, and non-driver passengers were more likely to be out-of-position. The physician needs to consider the environment of the occupant compartment when evaluating an injury.

Stone Mountain Middle School

About Stone Mountain Middle School

OVERVIEW Stone Mountain Middle School was the first school in the DeKalb County School System to pilot the middle school concept. The middle grades philosophy centers around a team approach, and each student is part of a team. Each team has four core teachers who teach English, math, science, and social studies. Four classes of students make up a team and circulate through the same core teachers. Besides the four core disciplines, Stone Mountain Middle School offers band, orchestra, French, Spanish and P.E. Through the exploratory enrichment blocks, students can experience art, chorus, music, computer applications, career education, Family & Consumer Science, and technology.

UNIQUE ASSETS

Stone Mountain Middle School is situated in a charming suburban community just east of metro Atlanta. The unique and impressive Stone Mountain creates a scenic background to our school campus. The faculty of Stone Mountain is multicultural, with widely diverse interests. Our student population is also diverse, representing twenty countries. In an effort to give our students varied experiences to grow and learn, we offer numerous clubs and school enrichment activities.

AWARDS AND RECOGNITIONS Our school is home to one of the most outstanding and award winning band programs in the district. We also host the Small Fry to Go program, a unique, award-winning year-long, project-based, science, mathematics, and communications program for middle school students developed by Georgia Tech University.

Stone Mountain Elementary

Stone Mountain Elementary

Core Values

Stone Mountain Elementary is a place where learning is our highest mission. We pledge to provide a respectful, caring and purposeful environment that values every child. We are committed to building character, celebrating improvement and honoring each other in our pursuit of excellence. Staying in the C.I.R.C.L.E. C-Care: compassion, empathy and understanding I-Improve: always giving our best effort, never settle for less R-Respect: treat other's how you want to be treated C-Cooperate: collaborate and work together L-Learn-personal excellence and success begins with learning E-Every day-committing to doing your best all the time

Meningitis outbreak highlights failed oversight efforts

FRAMINGHAM, Massachusetts (CNN) — If Sarah Sellers’ warnings had been taken seriously 10 years ago, 12 people might be alive today.

Sellers, a pharmacist and expert on the sterile compounding of drugs, testified to Congress in 2003 about non-sterile conditions she’d witnessed.

“Professional standards for sterile compounding have not been consistently applied,” she told the Senate Committee on Health, Education, Labor, and Pensions. “The absence of federal compounding regulations has created vulnerability in our gold standard system for pharmaceutical regulation.”

Nearly 10 years later, there are still no federal sterility guidelines for compounding pharmacies that make and distribute drugs all over the country.

Now, 137 cases and 12 fatalities nationwide are blamed on a rare, noncontagious form of meningitis linked to contaminated steroid injections made by the Massachusetts-based New England Compounding Center.

The latest death to be connected to the outbreak was that of a 70-year-old man who died in Florida in July, prior to the discovery of the contamination.

Tennessee is the hardest-hit state, with 39 infections and six deaths, according to the Centers for Disease Control and Prevention. Three deaths occurred in Michigan and one each in Maryland and Virginia, the CDC said.

Patients contracted the deadly meningitis after being injected in their spines with a preservative-free steroid called methylprednisolone acetate that was contaminated by a fungus. The steroid is used to treat pain and inflammation.

As many as 13,000 people may have received the medicine between May 21 and September 24, the CDC said.

The New England Compounding Center announced Wednesday it has established a recall operations center to manage the removal of all its products from circulation. Last week, the pharmacy voluntarily surrendered its license to operate until the Food and Drug Administration’s investigation into the contamination is complete.

Health officials say 75 medical facilities in 23 states received the contaminated steroid injections from NECC.

At least two lawmakers are introducing bills to strengthen the FDA’s oversight of compounding pharmacies.

“Unfortunately, compounding pharmacies are a 19th century service operating in a 21st century industry, and we need to update and strengthen the rules that govern these operations so that patients can safely benefit from the unique service they offer,” Rep. Edward Markey, D-Massachusetts, said in a statement. “I look forward to working with my colleagues to introduce this legislation and to ensure FDA has the authority it needs to oversee these pharmacies and protect patients.”

Rep. Rosa DeLauro, D-Connecticut, vowed similar action. “This outbreak and the corresponding recall of products from the New England Compounding Center expose dramatic gaps in our drug safety standards that create an unnecessary risk to the public health,” she wrote in a letter to Health and Human Services Secretary Kathleen Sebelius.

While compounding pharmacies were intended to create customized medications for specific patients, some “have evolved into large scale operations that produce sizeable quantities of some drugs,” she wrote. “For example, cases in the current outbreak are spread across nine states and more than 17,500 doses of the potentially contaminated drug were shipped to 23 states. At the same time, the FDA lacks clear authority for ensuring the safety of these products and last updated its guidance for (the) industry in 2002.”

The FDA has been working on new guidelines since at least 2006, but the effort is “still in progress,” FDA spokeswoman Erica Jefferson said.

Currently, the FDA does not have jurisdiction over compounding pharmacies until there is a problem. FDA officials say they have been fighting to change that for more than 20 years.

The compounding pharmacy industry has challenged those efforts, and courts have ruled that individual state health departments are in charge.

“These facilities are inspected upon initial licensure and in response to complaints,” said Alec Loftus of the Massachusetts Department of Public Health.

Massachusetts requires compound pharmacies to be licensed by the state board, but does not require accreditation. That’s a voluntary process that only 162 out of 3,000 compounding facilities have obtained, according to the Pharmacy Compounding Accreditation Board.

“The oversight appears to be quite lax,” said CNN’s chief medical correspondent Dr. Sanjay Gupta, reporting from Massachusetts about the contaminated drugs. The New England Compounding Center “can distribute thousands of doses of drugs and it doesn’t necessarily have to be accredited.”

The center’s building in Framingham is also home to a garbage compactor and recycling center. CNN observed a medical waste truck making a drop, as well as piles of garbage, boxes, and old mattresses on the back side of the pharmacy compound building. Both companies are owned by the same people.

If the site had been accredited, officials would have examined the facilities and considered whether there are concerns about the site sharing space with a garbage facility, Gupta said.

“Our investigation into NECC and the outbreak with our partners in Massachusetts are ongoing, so I can’t comment directly on how this factors in,” said Jefferson, the FDA spokeswoman.

There is no law that specifies a minimum proximity between a compounding pharmacy and other establishments.

The Massachusetts Department of Public Health has warned the NECC multiple times since 2002 about unsanitary conditions at its facility.

Statutory and regulatory requirements stipulate that compounding can be done only on receipt of a patient-specific prescription, Dr. Madeleine Biondolillo, director of the department’s Bureau of Healthcare Safety and Quality, told reporters Wednesday.

Asked if there had been a violation, she said some organizations may have operated contrary to the licensing regulations, but that is part of the investigation.

Compounding pharmacies were originally created for doctors or pharmacists to make small amounts of custom medications — for example, adding flavored syrup to a cough medicine, or creating a smaller dose for an individual patient if it’s not created commercially.

They’ve grown into a much larger business. Pharmacy compounding accounts for 37 million prescription drugs in the United States each year.

Some compounders ship thousands of custom drugs all over the country. NECC is licensed to distribute to surgery centers and pain clinics in 50 states.

Nearly 10% of drugs administered in the United States come from compound pharmacies, according to a 2003 Government Accountability Office report.

Meningitis is an inflammation of the protective membranes covering the brain and spinal cord. It is usually caused by an infection, frequently with bacteria or a virus, but it can also be caused by less common pathogens, such as fungi in this case, according to the CDC.

Fungal meningitis is very rare and, unlike viral and bacterial meningitis, is not contagious.

Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University Medical Center, told CNN that fungal infections are not usually mild. He said when a fungus invades small blood vessels, it can cause them to clot or bleed, which can lead to symptoms of small strokes.

In addition to typical meningitis symptoms like headache, fever, nausea and stiffness of the neck, people with fungal meningitis may also experience confusion, dizziness and discomfort from bright lights. Patients might just have one or two of these symptoms, the CDC says.

Health officials say any patients who received an injection at one of the facilities beginning May 21 and who began showing symptoms between one and three weeks after being injected should see their doctor right away.

The earlier a patient gets treatment, the more likely he or she will survive.

Patients are treated with anti-fungal medication, which is given intravenously, so patients have to be admitted to the hospital, the CDC said. Patients may need to be treated for months.

The FDA is urging anyone who has experienced problems following an injection with the NECC product to report it to MedWatch, the FDA’s voluntary reporting program, by phone at 1-800-FDA-1088 or online at www.fda.gov/medwatch/report.htm.

CNN’s Danielle Dellorto reported from Framingham; CNN’s Elizabeth Cohen and William Hudson reported from Atlanta. CNN’s Dr. Sanjay Gupta, Josh Levs and Ann Curley contributed to this report.

Drug firm linked to meningitis outbreak may have misled regulators

BOSTON —

The specialty pharmacy linked to a deadly meningitis outbreak may have misled regulators and done work beyond the scope of its state license, Massachusetts Gov. Deval Patrick said Wednesday.

Meanwhile, a second pharmacy connected to the New England Compounding Center in Framingham has shut down for state and federal inspection.

The New England Compounding Center made a steroid that was used in injections for back pain that were later found contaminated. More than 130 people in 11 states have been sickened. Twelve have died.

On Wednesday, Patrick told reporters that state and federal agencies "may have been misled by some of the information we were given" by the New England Compounding Center.

The company was licensed to fill specific prescriptions for specific patients but exceeded that, he said.

"What they were doing instead is making big batches and selling them out of state as a manufacturer would, and that is certainly outside of their state license," he said.

Massachusetts U.S. Rep. Ed Markey seized on Patrick's statement, and sent a letter to the U.S. Food and Drug Administration, asking if it believes it was misled by the company.

"This company may have disregarded federal guidelines, and we need to know from the FDA whether the company misled regulatory authorities and if sanctions against the company are available or warranted," Markey said.

A company spokesman declined comment beyond a statement that company officials are focused on cooperating with the investigation. The company has shut down operations, recalled the fungus-contaminated steroid and is cooperating with investigators.

On Wednesday afternoon, the state announced that drug provider Ameridose has agreed to temporarily shut down, pending inspection by state and federal regulators. Ameridose was founded in 2006 by Greg Conigliaro and Barry Cadden, who opened the New England Compounding Center eight years earlier.

Ameridose compounds drugs at one of its two facilities in Westborough, but also provides sterile medication in prefilled oral syringes to about 3,000 hospitals nationwide.

Dr. Madeleine Biondolillo, director of the state's Bureau of Healthcare Safety, said there's no evidence of problems at Ameridose and the state hasn't requested a recall of any Ameridose products.

A pharmacy manager at Ameridose, Sophia Pasedis, has been a member of the regulatory body, the Massachusetts Board of Registration in Pharmacy, since 2004. But the state said she has recused herself from all matters related to Ameridose and the New England Compounding Center.

Compounding pharmacies supply products that aren't commercially available, based on an individual doctor's prescription. Some have grown into larger businesses, operating across state lines and supplying drugs to thousands of hospitals, clinics and physicians.

Biondolillo said the state has reminded Massachusetts pharmacies that compounding can be done only in response to a patient-specific prescription. She said the state is now requiring all compounding pharmacies to sign an affidavit that they are following all regulations.

The state has 1,100 pharmacies that can compound drugs.

Massachusetts last inspected the New England Compounding Center in March in response to a pending complaint unrelated to the outbreak, officials have said. It also inspected the pharmacy in 2011 when it moved operations, and found no problems.

Asked if the state had tried to determine if the company was making large batches of drugs, a possible signal it was operating outside the bounds of its license, Biondolillo said, "Each time we go out and inspect, we're looking at all aspects of the operation."

She didn't give specifics about what the inspectors found in the most recent visit.

In Ohio, the state's board of pharmacy on Wednesday suspended the company's license to distribute in the state, citing evidence that the company's practices presented a danger of serious and immediate harm to others.

As many as 13,000 people received steroid shots from the New England Compounding Center, according to the federal Centers for Disease Control and Prevention.

Compounded drugs have never been reviewed for safety and effectiveness by the FDA. The outbreak has led to calls from lawmakers, including Markey and Connecticut Rep. Rosa DeLauro, to strengthen the agency's oversight over the drugs.

Meningitis cases linked to steroids increase; no California cases so far

LAKE COUNTY, Calif. – A meningitis outbreak linked to epidural steroid injections that so far is affecting the eastern half of the United States is continuing to grow, with health officials continuing to monitor patients in the North Coast region who received the steroids.

On Monday, the Centers for Disease Control and Prevention in Atlanta reported that the outbreak of fungal meningitis cases linked to contaminated methylprednisolone acetate injectable steroids had grown to 105 cases across nine states, with eight deaths.

No cases have so far been reported in California, the agency said.

Affected states included Florida, Indiana, Maryland, Michigan, Minnesota, North Carolina, Ohio, Tennessee and Virginia, according to the CDC, which is coordinating the investigation into the outbreak.

The CDC said the manufacturer of the methylprednisolone acetate injections, New England Compounding Center located in Framingham, Mass., began a voluntary recall of the drugs on Sept. 26.

State and federal officials said 75 health care facilities in 23 states received the contaminated product.

In California, four health facilities received the drug, which is used as an epidural injection for chronic pain.

Among them was Ukiah Valley Medical Center, which last week sent out letters to patients notifying them of the issues, as Lake County News has reported.

Also receiving the compound in California were the Cypress Surgery Center in Visalia, the Encino Outpatient Surgical Center and Universal Pain Management in Palmdale, the CDC reported.

To date, no patients have been admitted to UVMC with meningitis-type symptoms as a result of receiving this compound, the hospital said Monday.

Meningitis is a swelling of the meninges, the protective covering of the brain and spinal cord.

The CDC said infected patients have developed a variety of symptoms approximately one to four weeks following their injection. The symptoms include fever, new or worsening headache and nausea. Some also have suffered strokes.

The CDC investigation thus far has revealed that the meningitis linked to the steroid injections was caused by a fungus that is common in the environment but rarely causes meningitis. The source of the fungus, however, has not been identified.

Officials said the fungal meningitis in this outbreak is not contagious.

Anyone who has had one of the epidural steroid injections since May 21 should talk to their doctor immediately if they experience a worsening headache, fever, sensitivity to light, stiff neck, new weakness or numbness in any part of your body or slurred speech, according to the CDC.

In a Monday statement, UVMC said it selected the New England Compounding Center in spite of a 75 percent higher cost for the compounded medication because the center is a specialized “compounding-only pharmacy” dedicated to providing medications and services to patients and prescribers.

“The team of registered pharmacists at UVMC did not choose the product based on price,” according to Heather Van Housen, UVMC’s patient care executive.

“The product was selected because it contains no preservatives or buffers that other pharmaceutical manufacturers offer that may cause higher risk of infection or other complications,” Van Housen said.

STONE MOUNTAIN HIGH SCHOOL

STONE MOUNTAIN HIGH SCHOOL OverviewStone Mountain High School has been serving the community for over 100 years. It became a public school around the turn of the century, and was originally called the DeKalb High School. Stone Mountain High Values Our goal is to create an environment in which every student can be successful regardless of his or her socio-economic status, culture, physical challenges, or diverse family background. We will continue to create and maintain avenues of communication and support with the community and with parents. We believe in fostering pride in one's background and heritage and that one of our tasks is to help students maintain cultural identity while acquiring skills necessary to work effectively with all segments of society. Vision BRIDGE The Gap: Building Responsible Individuals Through Discipline, Guidance, and High Expectations Mission The mission of Stone Mountain High School is to provide students with the knowledge and skills to become productive and responsible citizens fostering a partnership with home, community, and school.

School Goals Students will improve upon critical thinking and reasoning skills and be involved in the learning process. Students will demonstrate the ability to cooperate with others and display respect for cultural diversity as the school staff strengthens participation among parents and community. Use a collaborative effort in decision-making. Continue to expand multicultural educational opportunities as we meet the educational needs of our student population. Continue development of effective strategies for parental and community involvement in the education of children. Expand professional development of teachers and administrators in teacher-student, teacher-parent, and teacher-administrator human relations skills and develop alternative methods of student discipline. Expand professional development of teachers and staff in improving student achievement. Improve student achievement as measured by standardized test scores, and recognize student successes. Explore projects/initiatives that reflect School of Excellence standards. Improve daily attendance rate.

Vehicle Damage Correlation to Injury Severity

Vehicle Damage Correlation to Injury Severity

               A recent NHTSA report shows that crash characteristics become more favorable for the occupant as the amount of residual deformation increases. This excludes crush intrusion into the occupant compartment. Robbins concluded that in crashes where there is no intrusion into the occupant compartment, “A common misconception formulated is that the amount of vehicle crash damage due to a collision, offers a direct correlation to the degree of occupant injury.” This author further emphasized that the concept of determining injury risk based from crush depth only is false reasoning. Although crush depth can be used for determining delta-Vs and PDOFs, other variables also must be considered before injury severity can be determined accurately. Many automobile insurance companies promote the myth that collision injuries correlate to the vehicle external structural damage and costs of repair, and have taken this position as a matter of policy. A claims adjuster might reject a claim, concluding that since there was only $1,000 worth of damage to the vehicle on a repair estimate, the person could not possibly be hurt, and not authorize any payment for treatment. On the other hand, the same adjuster might assume that since the car was totaled, the occupant must have significant injury, and authorize payment without any dispute. The assumption that the risk of injuries related to the amount of external vehicle damage in all types of crashes has little scientific basis.

               In a recent NHTSA report, Romilly et al. stated, “The mechanics of a high speedcollision are relatively well documented. The vehicle structure deforms, converting the system’s kinetic energy into sound, thermal, and strain energies. The rate of deformation is a result of the vehicle’s stiffness characteristics while the amount of recoverable deformation is a function of its elastic properties. At high impact speeds, very little elastic recovery occurs and the vehicle generally behaves as a plastic body. At low impact speeds, however, plastic behavior may be absent allowing most of the total impact injury to be recovered in elastic rebound. For the occupant, the best ride down profile occurs when the vehicle behaves as a plastic body with large deformations to reduce the overall acceleration. This creates a major dilemma for the manufacturer, occupant, and insurer. Each would like the vehicle to provide the maximum protection for the occupant with the minimum material damage to the vehicle during a collision. As the vehicle becomes stiffer, the vehicle damage costs are reduced as less permanent deformation takes place. However, the occupant experiences a more violent ride-down, which increases the potential for injury. This implies that vehicles that do not sustain permanent damage in low speed impacts produce correspondingly higher dynamic loadings ontheir occupants than those that deform plastically under the same or possibly more severe impact conditions

20 Things You Might Not Know About Alcohol

1  Sobering disclaimer: The family of compounds known as alcohols are all toxins that can kill you, whether instantly, quickly, or gradually.

2  Yet one of them—ethyl alcohol, or ethanol—is a staple of the human diet. Archaeologist Patrick McGovernspeculates that fermented beverages were made as early as 100,000 years ago, when people first spread out of Africa.

3  The seeds Johnny Appleseed sold to farmers throughout Ohio and Indiana produced apples that were inedible, but perfect for making hard cider.

4  According to the Drunken Monkey Hypothesis, our zest for alcoholic beverages derives from our distant ancestors’ impulse to seek the ripest, most energy-intensive fruits.

5  Designated driver at the zoo: The Malaysian pen-tailed treeshrew routinely chugs the equivalent of nine glasses of wine a night in naturally fermented nectar, and yet it remains fully functional.

6  For a treeshrew, that is.

7  Fermentation occurs when enzymes, typically produced by yeast, convert sugar molecules in grapes or grains into ethanol.

8  That process can also happen in your digestive system, spiking every 100 ml of blood with 0.01 to 0.03 mg of alcohol.

9  Seriously, officer! Japanese doctors have observed patients with “auto-brewery syndrome,” in which high levels of candida yeast in the intestines churn out so much alcohol that they can cause drunkenness.

10  No digestion required. Ethanol is such a small, simple molecule—just two carbon atoms, six hydrogens, and a spare oxygen—that it pours directly out of the stomach and small intestine into the bloodstream.

11  A lean, muscular person will be less affected by drink than someone with more body fat: Water-rich muscle tissues absorb alcohol effectively, preventing it from reaching the brain.

12  Drunkenness is considered an impairment of the neurons in your head, but Australian researchers recently reported that part of the feeling may result instead from the effect of ethanol on the brain’s immune system. The finding could lead to new treatments for alcoholism.

13  The times they are a-changin’. In 1895 Anheuser-Busch launched Malt-Nutrine, a 1.9 percent-alcohol-content beer prescribed by physicians as a tonic for pregnant women and a nutritional beverage for children.

14  Until 1916 whiskey and brandy were listed as scientifically approved medicines in the United States Pharmacopeia.

15  Drinking and driving: Surplus wine in Sweden is distilled into ethanol, mixed with gasoline, and sold to service stations.

16  Ethanol was widely used as an industrial fuel in America until a tax on alcoholic beverages, levied to help pay for the Civil War, prompted a switch to kerosene and methanol.

17  Methanol, a distillation 
of wood pulp, can destroy the optic nerves. “Blind drunk” was Prohibition-era slang for damage 
caused by drinking grain alcohol that had been cut with methanol by unscrupulous bootleggers.

18  Interstellar brewery: The nebulas where stars form abound with hydrogen, carbon, and oxygen, 
the atomic building blocks of alcohol.

19  Sure enough, astronomers found vast quantities of ethanol—as much as that in 400 trillion trillion beers—
in G34.3, an interstellar cloud some 10,000 light-years from Earth.

20  Resolution for 2012: Don’t stare at the cork. The 
carbon dioxide in champagne bottles creates 90 pounds of 
pressure per square inch, three times the pressure in automobile tires. Flying corks can cause retina detachment, double vision, and blindness. 

The Role of the Patient

No matter what else you do for yourself—diet, exercise, meditation, etc.—your body and mind can function more effectively when there is less distortion and less tension in your spine.

There is no substitute for the Chiropractic adjustment. With precise adjustments, it is possible to restore this softness and breadth to persons of any age or condition. All bodies naturally return to a state of more ease when the blockages are removed. Healthy people have spines that are softer, supple, and have more breadth than people who are experiencing more dis-ease.

As a Chiropractic patient, your awareness of healthy choices and practicing these will create a successful balance in your life. Wellness is a choice and the process of seeking more information on how to improve your physical, emotional, spiritual, social, and environmental well-being.

Reports from diverse spiritual traditions suggest the contemplation of subtle energies accelerate one’s development, especially along the spiritual and subtle cognitive lines. There is an innate intelligence organizing the body, and it is superior to the conscious thinking mind, Chiropractic care helps you to align with the flow of this inner intelligence and ideally with the infinite wisdom infusing all matter.

The central focus of the doctor of Chiropractic is to optimize patient health by correcting, managing, or minimizing vertebral subluxation through the Chiropractic spinal adjustment. Included in the Chiropractic philosophy is the notion that the least invasive form of treatment should be utilized before more invasive forms of treatment. The body should be given a chance to heal from the natural innate processes prior to provocation from more dangerous and harmful therapies. This can ONLY be accomplished if there is an intact structural environment housing the nervous system, allowing for proper communication between organ systems. If all else fails, then allopathic remedies are justified.

All of creation is emerging from the same source; everything is interconnected and affects everything else. Healing is a process of reintegrating mind, body, and spirit. To measure whether the healing is progressing, ask: “Are you finding out more about yourself?”

Memorial Day Tips & Safety

Each year, thousands of people are involved in traffic accidents during the Memorial Day Weekend. If you are one of these unfortunate people, will you know what to do in the aftermath of a collision? How you react can prevent further injuries, reduce costs and accelerate the clean-up and repair process.

Action Plan to Deal with Accidents:

1. Keep an Emergency Kit in Your Glove Compartment. Drivers should carry a cell phone, as well as pen and paper for taking notes, a disposable camera to take photos of the vehicles at the scene, and a card with information about medical allergies or conditions that may require special attention if there are serious injuries. Also, keep a list of contact numbers for law enforcement agencies handy. Drivers can keep this free fill-in-the-blanks accident information form in their glove compartment. The DocuDent™ Auto Accident Kit ($19.95), supported by AAA and insurance companies, offers a comprehensive kit that includes a flashlight, reusable camera and accident documentation instructions. A set of cones, warning triangles or emergency flares should be kept in the trunk.

2. Keep Safety First. Drivers involved in minor accidents with no serious injuries should move cars to the side of the road and out of the way of oncoming traffic. Leaving cars parked in the middle of the road or busy intersection can result in additional accidents and injuries. If a car cannot be moved, drivers and passengers should remain in the cars with seatbelts fastened for everyone's safety until help arrives. Make sure to turn on hazard lights and set out cones, flares or warning triangles if possible.

3. Exchange Information. After the accident, exchange the following information: name, address, phone number, insurance company, policy number, driver license number and license plate number for the driver and the owner of each vehicle. If the driver's name is different from the name of the insured, establish what the relationship is and take down the name and address for each individual. Also make a written description of each car, including year, make, model and color — and the exact location of the collision and how it happened. Finally, be polite but don't tell the other drivers or the police that the accident was your fault, even if you think it was.

4. Photograph and Document the Accident. Use your camera to document the damage to all the vehicles. Keep in mind that you want your photos to show the overall context of the accident so that you can make your case to a claims adjuster. If there were witnesses, try to get their contact information; they may be able to help you if the other drivers dispute your version of what happened.

5. File An Accident Report. Although law enforcement officers in many locations may not respond to accidents unless there are injuries, drivers should file a state vehicle accident report, which is available at police stations and often on the Department of Motor Vehicles Web site as a downloadable file. A police report often helps insurance companies speed up the claims process.

6. Know What Your Insurance Covers. The whole insurance process will be easier following your accident if you know the details of your coverage. For example, don't wait until after an accident to find out that your policy doesn't automatically cover costs for towing or a replacement rental car. Generally, for only a dollar or two extra each month, you can add coverage for rental car reimbursement, which provides a rental car for little or no money while your car is in the repair shop or if it is stolen. Check your policy for specifics.

Whiplash

What causes whiplash?

Whiplash occurs when the soft tissue in the spine is stretched and strained after the body is thrown in a sudden, forceful jerk. The injury most commonly occurs in car crashes involving sudden deceleration, but the injury can also occur in other strenuous physical activities such as diving.

What does whiplash feel like?

The most frequent complaints are headaches and stiffness in the neck and the back of the head. These symptoms appear within the first couple of days after the accident and usually pass after a few days to a few weeks.

Chiropractic Care for Whiplash

Whiplash Chiropractic

Pain and stiffness in the neck which may not come on immediately, but develop over the following 24 to 48 hours. You may have reduced range of movement in the cervical spine (neck). You may have headaches, dizziness, blurred vision (this should go within 24 hours, if they persist consult your doctor), pain and stiffness may last a few days, to a few weeks, depending on the severity.

The primary whiplash treatment for joint dysfunction, spinal manipulation involves the chiropractor gently moving the involved joint into the direction in which it is restricted.

Whiplash is common in car accidents, due in part to the fact that the muscles do not have enough time to brace during impact.

Simple cases of whiplash are the result of strain or sprained or dysfunction of ligaments in the neck. The muscles of the neck naturally spasm as a protective mechanism after an injury has occurred. This in turn can cause spinal misalignment which can irritate nerves reducing the body’s ability to heal itself.

You Are Amazing

The body is one of the great wonders of the universe!

Did you know?

- There are 45 miles of nerves just in your skin.
- You are about 70 percent water.
- Your body has about 5.6 liters (6 quarts) of blood.
- In the brain there are 1,000,000,000,000 (a million million) individual nerve cells.
- There are more synapses in the brain than there are stars in the universe.
- You enteric nervous system (Gut brain) has over 100 million neuron.
- You give birth to 100 billion new red cells every day.
- Your brain generates more electrical impulses than all of the world's telephones.
- Your lungs inhale over two million liters of air every day.
- Your 5.6 liters of blood circulates through the body three times every minute.
- In 24 hours, the blood in your body travels a total of 12,000 miles.
- Nerve impulses to and from the brain travel as fast as 170 miles per hour.
- The tooth is the only part of you that can't repair itself.
- The life span of a taste bud is ten days.
- Your brain consumes 20 percent of the body’s energy.

Diagnosis

2. Diagnosis

In 80% of cases the cause of pain cannot be established.

Quebec Task Force on Spinal Disorders: Spine 1987; 12:S1-S59

85% of pain patients lack a specific diagnosis.

Deyo et al: JAMA 1992;268:760-765

The diagnosis helps to determine the necessity of treatment and causation.

There is no such thing as a “chronic sprain / strain injury”.

The use of the “sprain strain” as a diagnosis after 4-6 weeks without proper documentation is not a valid diagnosis.

Of the people injured (only approximately 50% of people injured in accidents) 75% will heal within 2-3 months. These patients sustained minor injuries to their muscles and ligaments, but not to their discs or facet joints. 10% of patients with injuries will progress to chronic symptoms. These patients injured their intervetebral discs, zygapophyseal joints, or alar ligaments. These patients will not resolve spontaneously and they may become chronic. Bansley, Lord, Bogduk. Whiplash Injury: Clinical Review. Pain 58, 1994, 283-307.

We use professionally and nationally accepted guidelines that take into consideration the diagnosed conditions considering any complicating factors. (Croft, Quebec, Austrian, ABIME)

See more at www.painatlanta.com. 

Stone Mountain Pain Clinic

Arthritis Prevalence: A Nation in Pain

Arthritis is a term used to describe more than 100 different conditions that affect joints as well as

other parts of the body. Arthritis is one of the most prevalent chronic health problems and one of

the nation’s most common causes of disability.

[CDC. Prevalence of disabilities and associated health conditions among adults – United States, 1999. MMWR 2001; 50: 120 – 5.]

An estimated 46 million adults in the United States reported being told by a doctor that

they have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia.

[MMWR 2006;55(40):1089-1092. [Data Source: 2003–2005 NHIS]

One in five (21%) adults in the United States report having doctor-diagnosed arthritis.

[MMWR 2006;55(40):1089-1092. [Data Source: 2003–2005 NHIS]

By 2030, an estimated 67 million of Americans aged 18 years or older are projected to have

doctor-diagnosed arthritis.

[Arthritis & Rheumatism 2006;54(1):226-229 [Data Source: 2003 NHIS]

Two-thirds of the people that have doctor-diagnosed arthritis are under the age of 65.

[MMWR 2006;55(40):1089-1092. [Data Source: 2003–2005 NHIS]

In 2003, arthritis and rheumatic conditions cost the U.S. economy $128 billion.

[MMWR 2007;56(01):4-7. [Data Source: 2003 Medical Expenditure Panel Survey]

Arthritis is the second most frequently reported chronic condition in the United States.

[Benson, V. & Marano, M. (1998). Current Estimates from the National Health Interview Survey, 1995. Vital & Health Statistics 10, 199, 1-428].

Arthritis prevalence increases with age. Among adults over age 65, the prevalence of

arthritis is 50 percent.

[MMWR 2006;55(40):1089-1092. [Data Source: 2003–2005 NHIS]

The prevalence of arthritis is higher among women (28.3%) than men (18.2%).

[MMWR 2006;55(40):1089-1092.] [Data Source: 2003–2005 NHIS]

If prevalence rates remain stable, the number of affected persons ages 65 years and older

will nearly double to 41.1 million by 2030.

[CDC (2003). Public health and aging: projected prevalence of self-reported arthritis or chronic joint symptoms among persons aged >65 years--United States,

2005-2030. MMWR, 52, 489-491]

59 million people report having low back pain.

[Helmick, C., Felson, D., Lawrence, R., Gabriel, S., et all. Estimates of the Prevalence of Arthritis and Other Rheumatic conditions in the United States. Arthritis &

Rheumatism 58(1), 15-25. 2008]

30 million people report having neck pain.

[Helmick, C., Felson, D., Lawrence, R., Gabriel, S., et all. Estimates of the Prevalence of Arthritis and Other Rheumatic conditions in the United States. Arthritis &

Rheumatism 58(1), 15-25. 2008]

Factors in the Diagnosis of Disc Herniations

Factors in the Diagnosis of Disc Herniations

                Lowback pain is a complex condition, and accurate diagnosis can be difficult. A current study examined a group of “Forty-six patients with low back pain and sciatica severe enough to require a disentomb” and 46 asymptomatic volunteers who were matched for age and work-related risk factors (heavy lifting, twisting and bending, vibration, or sedentary). Both groups were given a complete clinical exam, MRI, and psychological questionnaires. 

                MRI findings: “In 76% of the asymptomatic volunteers a disc herniation (I.e., protrusion, extrusion, or sequestration) was present at least at one level…In all, 85% of the matched control subjects without previous back pain exhibited disc degeneration at least at one level. In the patient group, 96% showed at least one degenerative change.” Patients, however, had an 82% rate of neural compromise, while controls had only a 21% rate. 

                The authors found that pain patients were more likely to have signs of neurological compromise, were more likely to be depressed or anxious, were more likely to be married, and had higher levels of work stress.

                The study also warns against using MRI alone as indications for surgery. For instance, if surgery is based on MRI-detected disc herniations alone, there is a false positive rate of 76%; for MRI-detected disc degeneration, there is a false positive rate of 85%.