PodcastDX

FROM SURVIVAL TO QUALITY OF LIFE: WHY OUTCOMES ARE BEING REDEFINED THE FUNDAMENTAL SHIFT IN MEDICINE For decades, medicine measured success through a singular lens: survival. Did the patient live? Did the procedure work? While these metrics remain important, healthcare is undergoing a profound transformation that redefines what "winning" actually means[1]. The new standard is no longer just extending life—it's enabling patients to live purposefully, functionally, and with dignity[2]. This shift reflects a critical insight: surviving is not the same as living well. WHY OUTCOMES ARE BEING REDEFINED Beyond Binary Success Traditional outcome metrics operated in black-and-white terms. A femur repair was "successful" if the fracture healed—regardless of whether the patient could walk without pain, climb stairs, or return to work[3]. Today, healthcare systems recognize this approach as incomplete and outdated. Patient-Reported Outcomes Measures (PROMs) The healthcare industry is now systematically integrating patient voices into outcome measurement. These tools capture what patients actually experience: physical functioning, emotional well-being, social participation, and overall quality of life[4]. The Centers for Medicare & Medicaid Services (CMS) has formally incorporated patient-reported outcome measures into quality reporting frameworks, signaling a structural shift in how healthcare success is defined[5]. The Quintuple Aim Modern healthcare reform is reframing success across five dimensions[6]: ·      Patient Experience: Tailored treatments based on individual data and preferences ·      Population Health: Proactive, preventative care delivery ·      Cost Reduction: Connecting patients to appropriate care and reducing avoidable hospitalizations ·      Provider Well-Being: Extending clinical reach through technology and team-based care ·      Equitable Care: Ensuring access regardless of geography or circumstance WHAT THIS MEANS IN PRACTICE Real-World Impact Advanced remote patient monitoring programs demonstrate the difference this redefinition makes. One program achieved a 230% increase in guideline-directed medical therapy for heart failure patients, adding an average of 5 years to their lives—but the metric that matters most is that patients remained home, maintained independence, and preserved quality of life while achieving better clinical outcomes[7]. Shared Decision-Making Patient preferences now matter. Research shows patients are generally unwilling to accept diminished quality of life simply for extended survival[8]. Healthcare providers increasingly recognize that authentic patient partnership—understanding what matters most to each individual—leads to better adherence, satisfaction, and actual outcomes. THE BOTTOM LINE The redefinition of medical success from "Did you survive?" to "Are you living well?" represents a maturation of healthcare. It acknowledges that modern medicine can often extend life—the question now is how to ensure that extended life is worth living. This shift places patient values, functional abilities, and personal purpose at the center of clinical decision-making. Success in 21st-century medicine means helping patients achieve not just survival, but flourishing. REFERENCES [1] Takeda Oncology. (2025). Living beyond surviving: Patient-centered approach to modern oncology care. Retrieved from https://www.takedaoncology.com/our-stories/living-is-more-than-surviving/ [2] LaBier, D. (2014). Life purpose beyond survival as a metric of quality healthcare. LinkedIn. Retrieved from https://www.linkedin.com/pulse/20140526192226-11896706--life-purpose-beyond-survival-as-a-metric-of-quality-healthcare/ [3] University of South Carolina. (2025). Patient-reported outcome measures essential to clinical decision-making. Retrieved from https://www.sc.edu/uofsc/posts/2025/10/10-patient-centered-quality-measures.php [4] Sermo. (2026). 13 strategies to improve patient care quality in 2026. Retrieved from https://www.sermo.com/resources/13-solutions-for-improving-patient-care-and-outcomes-in-2025/ [5] Medisolv. (2024). Trends in healthcare quality and safety to watch in 2024. Retrieved from https://blog.medisolv.com/articles/healthcare-trends-2024/ [6] Cunningham, E., Chief of Virtual Care and Digital Health, Providence Health. (2024). Cadence outcomes report insights. Cadence Care. Retrieved from https://www.cadence.care/post/cadences-2024-outcomes-report-a-new-era-in-primary-care/ [7] Cadence Care. (2024). Cadence's 2024 outcomes report: A new era in primary care. Retrieved from https://www.cadence.care/post/cadences-2024-outcomes-report-a-new-era-in-primary-care/ [8] PubMed Central. (2008). Patient preferences: Survival vs. quality-of-life considerations. Retrieved from https://pubmed.ncbi.nlm.nih.gov/8410398/

AI in medicine is best understood as a powerful tool and a conditional partner that can enhance care when tightly supervised by clinicians, but it becomes a problem when used as a replacement, deployed without oversight, or embedded in biased and opaque systems. Whether it functions more as a partner or a problem depends on how health systems design, regulate, and integrate it into real clinical workflows.​ Where AI Works Well Decision support and diagnosis: AI can read imaging, ECGs, and lab patterns with very high accuracy, helping detect cancers, heart disease, and other conditions earlier and reducing some diagnostic errors.​ Workflow and documentation: Tools that draft visit notes, summarize records, and route messages can cut administrative burden and free up clinician time for patients.​ Patient monitoring and triage: Algorithms can watch vital signs or wearable data to flag deterioration, triage symptoms online, and guide patients through care pathways, which is especially valuable with clinician shortages.​ Risks and Problems Errors, over-reliance, and "automation bias": Studies show clinicians sometimes follow incorrect AI recommendations even when the errors are detectable, which can lead to worse decisions than if AI were not used.​ Bias and inequity: If training data underrepresent certain groups, AI can systematically misdiagnose or undertreat them, amplifying existing health disparities.​ Trust, explainability, and liability: Black-box systems can undermine shared decision-making when neither doctor nor patient can understand or challenge a recommendation, and they raise hard questions about who is responsible when harm occurs.​ Impact on the Doctor–Patient Relationship Potential partner: By handling routine documentation and data crunching, AI can give clinicians more time for conversation, empathy, and shared decisions, supporting more person-centered care.​ Potential barrier: If AI outputs dominate visits or generate long lists of differential diagnoses directly to patients, it can increase anxiety, fragment communication, and weaken relational trust.​ How To Keep AI a Partner, Not a Problem Keep humans in the loop: Use AI as a second reader or coach, not a final decision-maker; clinicians should retain authority to accept, modify, or reject suggestions.​ Demand transparency and evaluation: Health systems should validate tools locally, monitor performance across different populations, and disclose AI use to patients in clear language.​ Align incentives with patient interests: Regulation, reimbursement, and malpractice rules should reward safe, equitable use of AI—not just speed, volume, or commercial uptake.​ In practice, AI in medicine becomes a true partner when it augments human judgment, enhances relationships, and improves outcomes; it becomes a problem when it is opaque, biased, or allowed to replace clinical responsibility.​        

Medicine has transitioned due to massive tech adoption (Electronic Health Records EHRs, Artificial Intelligence AI, Telehealth), shifting patient expectations (consumerism, convenience), the rise of value-based care, new treatments (precision medicine), and increased focus on population health and prevention, all while grappling with rising costs, data security, and persistent access/equity gaps, making healthcare more data-driven, personalized, and digitally integrated but also more complex and fragmented.  We try to break it down to try and understand the changes and how they might improve the outcomes when going to the doctor.     Technological Revolution Electronic Health Records (EHRs) & Analytics: Widespread EHR adoption (95% of hospitals by 2017) streamlined data, enabling better analytics for management, diagnosis, and care coordination, notes HNI Healthcare and Becker's Hospital Review. Telehealth & Wearables: Virtual visits, health apps, and fitness trackers (like heart rate monitors) became common, improving access and remote monitoring, says ThriveAP. Artificial Intelligence (AI) & Machine Learning: AI now analyzes complex data for diagnostics, research, and clinical decisions, says Health Tech Academy and National Institutes of Health (NIH) | (.gov).  Evolving Patient & Provider Landscape Consumerism: Patients demand convenient, personalized care, challenging traditional models, notes Marathon Health and NEJM Catalyst Innovations in Care Delivery. New Care Models: Integration (ACOs, hospitalists) aimed at better quality/cost, but challenges in coordination persist, according to the National Institutes of Health (NIH) | (.gov). Population Health: Greater focus on prevention, chronic disease management (diabetes, obesity), and public health crises (COVID-19), says Health Data Management.  Shifting Medical Focus & Costs Precision Medicine: Tailored treatments using biomarkers are improving efficacy, notes faCellitate. Rising Costs: More expensive tech, drugs (like gene therapies), and increased demand contribute to significant spending increases, say National Institutes of Health (NIH) | (.gov) and Springer Publishing Company. Data & Billing Changes: The shift to complex coding (like ICD-10) improved data but added operational hurdles, say Becker's Hospital Review and National Institutes of Health (NIH) | (.gov) pmc.ncbi.nlm.nih.gov  . 

​ This week we discuss stem cells.  Having great therapeutic and biotechnological potential, stem cells are extending the frontier in medicine. Not only replace dysfunctional or damaged cells, the so-called regenerative medicine, stem cells may also offer us new perspectives regarding the nature of aging and cancer. This review will cover some basics of stem cells, their current development, and possible applications in medicine. Meanwhile, important remaining challenges of stem cell research are discussed as well. ​Stem cells are unique, unspecialized cells that can divide to create more stem cells (self-renewal) and can transform (differentiate) into various specialized cells, acting as the body's repair system to generate new cells for growth, repair, and maintenance, with different types existing in embryos (pluripotent) and adults (multipotent) and being studied for treating diseases like paralysis, diabetes, and heart disease.   Types of Stem Cells Embryonic Stem Cells: Pluripotent (can become almost any cell type) and come from early embryos.  Adult Stem Cells (Tissue-Specific): Multipotent (limited to certain cell types within their tissue) and found in adult organs like bone marrow, skin, and the brain.  Induced Pluripotent Stem Cells (iPSCs): Adult cells reprogrammed in the lab to act like embryonic stem cells, offering a path to personalized medicine.  ​Sources of Stem Cells Embryos (for research), Umbilical cord blood, Bone marrow, Other adult tissues (like fat or skin). ​Medical Significance (Stem Cell Therapy) Regenerative Medicine: Uses stem cells to repair or replace damaged tissues and organs.  Treatments: Already used to treat blood cancers (like leukemia) through bone marrow transplants.  Research Focus: Investigated for treating conditions such as spinal cord injuries, Parkinson's, Alzheimer's, heart disease, and diabetes.  ​There is some stem cell controversy, primarily centering on the ethics of using human embryos, particularly embryonic stem cells, which hold vast potential for medicine but require destroying the embryo, raising moral debates about the embryo's status as human life, with opponents seeing it as the destruction of life and proponents viewing it as a moral imperative to cure disease, though adult stem cell research and induced pluripotent stem cells (iPSCs) offer less controversial avenues.  We don't discuss this aspect of the therapeutic use but if you are interested you can find out more with a simple internet search. ​Stem cell therapy in the US is not banned but restricted. Only FDA-approved products (such as cord blood transplants and CAR-T cell therapies for blood conditions) are fully legal. Other uses are allowed only in limited cases under the 361 HCT/P pathway.

This week we will discuss the topic of "functional fitness"  With the new year upon us many people want to add fitness or getting healthy as goals and we are here to help! Functional fitness is a simple, effective way to keep your body moving and reduce restlessness. It focuses on exercises that help you perform everyday activities more easily and safely—like getting up off the floor, carrying groceries, or reaching for items on a shelf. By training your muscles to work the way you actually use them in daily life, functional fitness reduces injury risk and improves overall quality of life. It helps you move through your day with more confidence, strength, and ease. Fitness expert Brad Schoenfeld describes functional fitness as existing "on a continuum." In other words, almost any exercise can be functional if it improves your ability to move well in real life. While general strength training is beneficial, exercises that mimic everyday movements tend to offer the greatest payoff. Functional fitness also improves balance, endurance, and flexibility—benefits that matter at every age. Below are 13 functional exercises suitable for adults of all ages. Choose five or six and perform them three to four times per week. All can be done safely at home with minimal equipment. 1. Squat Squats mimic sitting and standing from a chair, making them one of the most important functional movements. Move slowly and with control. To modify, reduce depth or use a chair for support. 2. Incline Chest Press This exercise strengthens the muscles used to push yourself up from the floor or a surface. It's a gentler alternative to pushups and works the same muscle groups. 3. Plank Planks build core strength, balance, and mobility—skills needed for getting up and down from the floor. Focus on maintaining good form rather than duration. 4. Wall Squat Wall squats provide added support and reduce strain on the lower back while still strengthening the legs. 5. Step-Down This movement improves balance and stability and mimics stepping down from stairs or high surfaces. 6. Row Rows strengthen the back and arms, helping with tasks like lifting objects from shelves or pulling items toward you. 7. Stationary Lunge Lunges replicate the motion of standing up from the ground and improve leg strength and joint mobility. 8. Step-Up Step-ups strengthen the muscles used for climbing stairs and stepping onto raised surfaces. 9. Single-Leg Lift Single-leg exercises improve balance and core stability, which helps prevent falls. 10. Side Plank Side planks target the oblique muscles and support overall core strength. 11. Downward-Facing Dog This yoga pose builds strength, flexibility, and balance while supporting your body weight. 12. Single-Leg Deadlift Deadlifts train the hip hinge and strengthen multiple leg muscles, preparing you for lifting objects safely. 13. Lunge with Bent-Over Row This combined movement challenges balance while strengthening both the lower and upper body. Takeaway Functional fitness prepares your body for real-life movement. It emphasizes performance over appearance, uses minimal equipment, and carries a lower risk of injury than high-intensity training styles. Because it focuses on practical strength and movement quality—not muscle size—it's accessible, effective, and appropriate for people of all ages and fitness levels. If you have existing injuries or medical conditions, consult a healthcare provider before starting.

By the end of the first week of the new year, nearly 77% of New Year's resolutions have already failed (Norcross, 1988). That's discouraging—but it doesn't mean you should stop trying. It means most of us are setting resolutions in ways that don't work. You aren't weak or lazy. More often, the problem is a misaligned system—one that relies too heavily on willpower and short-lived motivation. Motivation naturally fades over time, even when our intentions are good. Think about how often you enthusiastically agree to plans weeks in advance, only to feel tired or unmotivated when the day arrives. Or how many times you've started a project—cleaning a room, taking a course, planning a trip—only to watch your early excitement slowly disappear. We're excellent at strong intentions; follow-through is harder. The good news? Not all resolutions fail. That same research found that 19% of resolutions are still maintained two years later (Norcross, 1988). We just don't spend enough time learning from what does work. Three DON'Ts 1. Don't make life-changing, all-or-nothing resolutions Resolutions that try to overhaul everything at once are overwhelming and fragile. Examples: "New year, new me—I'll reinvent my career, relationships, and lifestyle." "I'll work out every single day this year." "I'll triple my income or eliminate all my debt." Why this fails: One setback can feel like total failure, making it easy to quit entirely. 2. Don't set shame-driven goals Goals rooted in self-criticism, embarrassment, or self-loathing undermine motivation. Examples: "I need to get my life together." "I have to lose weight so I don't look bad." "This year I'll stop being lazy." Why this fails: Shame erodes self-belief and increases anxiety, making lasting change harder—not easier. 3. Don't set vague resolutions Unclear goals are difficult to act on. Examples: "I want to be healthier." "I'll work on myself." "I need better boundaries." Why this fails: Without clear actions or markers of success, procrastination takes over and goals fade. Three DOs Meaning Choose one small, consistent practice that reflects what truly matters to you. Examples: "Every Sunday evening, I'll spend an hour writing, painting, or making music." "Once a week, I'll take a phone-free walk to reflect." Purpose Connect your resolution to generativity—contributing beyond yourself (Erikson, 1950). Examples: "I'll volunteer or mentor through an organization like SCORE or Rotary." Connection Create simple, recurring rituals with others. Example: "I'll schedule a weekly call, walk, or shared meal and treat it as a real commitment." Traditional New Year's resolutions don't fail because people lack discipline. They fail because they're poorly designed—too big, too vague, or rooted in shame. When resolutions focus on "fixing what's wrong," they often lead to self-criticism once early motivation fades. In contrast, resolutions grounded in meaning, purpose, and connection are more sustainable. If you're among the 77% whose resolution didn't stick, don't fall into the shame trap. A broken resolution isn't failure—it's feedback. Reset your expectations, adjust your strategy, and start again with something manageable. Move away from punishment and toward practices that bring joy, meaning, and connection. That shift alone can make the difference between another abandoned resolution and one that truly lasts. May your year be filled with meaning, purpose, and connections that sustain you. (CREDITS: PSYCHOLOGY TODAY)

The lymphatic system, or lymphoid system, is one of the components of the circulatory system, and it serves a critical role in both immune function and surplus extracellular fluid drainage.  Components of the lymphatic system include lymph, lymphatic vessels and plexuses, lymph nodes, lymphatic cells, and a variety of lymphoid organs. The pattern and form of lymphatic channels are more variable and complex but generally parallel those of the peripheral vascular system. The lymphatic system partly functions to convey lymphatic fluid, or lymph, through a network of lymphatic channels, filter lymphatic fluid through lymph nodes and return lymphatic fluid to the bloodstream, where it is eventually eliminated. Nearly all body organs, regions, and systems have lymphatic channels to collect the various byproducts that require elimination . Liver and intestinal lymphatics produce about 80% of the volume of lymph in the body. Notable territories of the body that do not appear to contain lymphatics include the bone marrow, epidermis, as well as other tissues where blood vessels are absent. The central nervous system was long considered to be absent of lymphatic vessels until they were recently identified in the cranial meninges. Moreover, a vessel appearing to have lymphatic features was also discovered in the eye. The lymphatic system is critical in a clinical context, particularly given that it is a major route for cancer metastasis and that the inflammation of lymphatic vessels and lymph nodes is an indicator of pathology.  Structure The lymphatic system includes numerous structural components, including lymphatic capillaries, afferent lymphatic vessels, lymph nodes, efferent lymphatic vessels, and various lymphoid organs.  Lymphatic capillaries are tiny, thin-walled vessels that originate blindly within the extracellular space of various tissues. Lymphatic capillaries tend to be larger in diameter than blood capillaries and are interspersed among them to enhance their ability to collect interstitial fluid efficiently. They are critical in the drainage of extracellular fluid and allow this fluid to enter the closed capillaries but not exit due to their unique morphology. Lymphatic capillaries at their blind ends are composed of a thin endothelium without a basement membrane. The endothelial cells at the closed end of the capillary overlap but shift to open the capillary end when interstitial fluid pressure is greater than intra-capillary pressure. This process permits lymphocytes, interstitial fluid, bacteria, cellular debris, plasma proteins, and other cells to enter the lymphatic capillaries. Special lymphatic capillaries called lacteals exist in the small intestine to contribute to the absorption of dietary fats. Lymphatics in the liver contribute to a specialized role in transporting hepatic proteins into the bloodstream. The lymphatic capillaries of the body form large networks of channels called lymphatic plexuses and converge to form larger lymphatic vessels. Lymphatic vessels convey lymph, or lymphatic fluid, through their channels. Afferent (toward) lymphatic vessels convey unfiltered lymphatic fluid from the body tissues to the lymph nodes, and efferent (away) lymphatic vessels convey filtered lymphatic fluid from lymph nodes to subsequent lymph nodes or into the venous system. The various efferent lymphatic vessels in the body eventually converge to form two major lymphatic channels: the right lymphatic duct and the thoracic duct.  The right lymphatic duct drains most of the right upper quadrant of the body, including the right upper trunk, right upper extremity, and right head and neck. The right lymphatic trunk is a visible channel in the right cervical region just anterior to the anterior scalene muscle. Its origin and termination are variable in morphology, typically forming as the convergence of the right bronchomediastinal, jugular, and subclavian trunks, extending 1 to 2 centimeters in length before returning its contents to the systemic circulation at the junction of the right internal jugular, subclavian, and/or brachiocephalic veins.  The thoracic duct, also known as the left lymphatic duct or van Hoorne's canal, is the largest of the body's lymphatic channels. It drains most of the body except for the territory of the right superior thorax, head, neck, and upper extremity served by the right lymphatic duct. The thoracic duct is a thin-walled tubular vessel measuring 2 to 6 mm in diameter. The length of the duct ranges from 36 to 45 cm. The thoracic duct is highly variable in form but typically arises in the abdomen at the superior aspect of the cisterna chyli, around the level of the twelfth thoracic vertebra (T12). The cisterna chyli, from which it extends, is an expanded lymphatic sac that forms at the convergence of the intestinal and lumbar lymphatic trunks extending along the L1-L2 vertebral levels. The cisterna chyli is present in approximately 40-60% of the population, and in its absence, the intestinal and lumbar lymphatic trunks communicate directly with the thoracic duct at the T12 level. As a result, the thoracic duct receives lymphatic fluid from the lumbar lymphatic trunks and chyle, composed of lymphatic fluid and emulsified fats, from the intestinal lymphatic trunk. Initially, the thoracic duct is located just to the right of the midline and posterior to the aorta. It exits the abdomen and enters the thorax via the aortic hiatus formed by the right and left crura of the diaphragm, side by side with the aorta. The thoracic duct then ascends in the thoracic cavity just anterior and to the right of the vertebral column between the aorta and azygos vein. At about the level of the fifth thoracic vertebra (T5), the thoracic duct typically crosses to the left of the vertebral column and posterior to the esophagus. From here, it ascends vertically and usually empties its contents into the junction of the left subclavian and left internal jugular veins in the cervical region. To ensure that lymph does not flow backward, collecting lymphatic vessels and larger lymphatic vessels have one-way valves. These valves are not present in the lymphatic capillaries. These lymphatic valves permit the continued advancement of lymph through the lymphatic vessels aided by a pressure gradient created by vascular smooth muscle, skeletal muscle contraction, and respiratory movements. However, it is important to note that lymphatic vessels also communicate with the venous system through various anastomoses. Lymph nodes are small bean-shaped tissues situated along lymphatic vessels. Lymph nodes receive lymphatic fluid from afferent lymphatic vessels and convey lymph away through efferent lymphatic vessels. Lymph nodes serve as a filter and function to monitor lymphatic fluid/blood composition, drain excess tissue fluid and leaked plasma proteins, engulf pathogens, augment an immune response, and eradicate infection. Several organs in the body are considered to be lymphoid or lymphatic organs, given their role in the production of lymphocytes. These include the bone marrow, spleen, thymus, tonsils, lymph nodes, and other tissues. Lymphoid organs can be categorized as primary or secondary lymphoid organs. Primary lymphoid organs are those that produce lymphocytes, such as the bone marrow and thymus. Bone marrow is the primary site for the production of lymphocytes. The thymus is a glandular organ located anterior to the pericardium. It serves to mature and develop T cells, or thymus cell lymphocytes, in response to an inflammatory process or pathology. As individuals age, both their bone marrow and thymus reduce and accumulate fat. Secondary lymphoid organs serve as territories in which immune cells function and include the spleen, tonsils, lymph nodes, and various mucous membranes, such as in the intestines. The spleen is a purplish, fist-sized organ in the left upper abdominal quadrant that contributes to immune function by serving as a blood filter, storing lymphocytes within its white pulp, and being a site for an adaptive immune response to antigens. The lingual tonsils, palatine tonsils, and pharyngeal tonsils, or adenoids, work to prevent pathogens from entering the body. Mucous membranes in the gastrointestinal, respiratory, and genitourinary systems also function to prevent pathogens from entering the body. Lymph Lymphatic fluid, or lymph, is similar to blood plasma and tends to be watery, transparent, and yellowish in appearance. Extracellular fluid leaks out of the blood capillary walls because of pressure exerted by the heart or osmotic pressure at the cellular level. As the interstitial fluid accumulates, it is picked up by the tiny lymphatic capillaries along with other substances to form lymph. This fluid then passes through the lymphatic vessels and lymph nodes and finally enters the venous circulation. As the lymph passes through the lymph nodes, both monocytes and lymphocytes enter it.  Lymph is composed primarily of interstitial fluid with variable amounts of lymphocytes, bacteria, cellular debris, plasma proteins, and other cells. In the GI tract, lymphatic fluid is called chyle and has a milk-like appearance that is chiefly due to the presence of cholesterol, glycerol, fatty acids, and other fat products. The vessels that transport the lymphatic fluid from the GI tract are known as lacteals. Embryology The development of the lymphatic system is known from both human and animal, especially mouse studies. The lymphatic vessels form after the development of blood vessels, around six weeks post-fertilization. The endothelial cells that serve as precursors to the lymphatics arise from the embryonic cardinal veins. The process by which lymphatic vessels form is similar to that of the blood vessels and produces lymphatic-venous and intra-lymphatic anastomoses, but diverse origins exist for components of lymphatic vessel formation in different regions.  Six primary lymph sacs develop and are app

This week we are talking about Pancreatic cancer.  This is a type of cancer that begins as a growth of cells in the pancreas. The pancreas lies behind the lower part of the stomach. It makes enzymes that help digest food and hormones that help manage blood sugar. The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma. This type begins in the cells that line the ducts that carry digestive enzymes out of the pancreas. Pancreatic cancer rarely is found at its early stages when the chance of curing it is greatest. This is because it often doesn't cause symptoms until after it has spread to other organs. Your health care team considers the extent of your pancreatic cancer when creating your treatment plan. Treatment options may include surgery, chemotherapy, radiation therapy or a mix of these. Pancreatic cancer often doesn't cause symptoms until the disease is advanced. When they happen, signs and symptoms of pancreatic cancer may include: Belly pain that spreads to the sides or back. Loss of appetite. Weight loss. Yellowing of the skin and the whites of the eyes, called jaundice. Light-colored or floating stools. Dark-colored urine. Itching. New diagnosis of diabetes or diabetes that's getting harder to control. Pain and swelling in an arm or leg, which might be caused by a blood clot. Tiredness or weakness. It's not clear what causes pancreatic cancer. Doctors have found some factors that might raise the risk of this type of cancer. These include smoking and having a family history of pancreatic cancer. Understanding the pancreas The pancreas is about 6 inches (15 centimeters) long and looks something like a pear lying on its side. It releases hormones, including insulin. These hormones help the body process the sugar in the foods you eat. The pancreas also makes digestive juices to help the body digest food and take in nutrients. How pancreatic cancer forms Pancreatic cancer happens when cells in the pancreas develop changes in their DNA. A cell's DNA holds the instructions that tell a cell what to do. In healthy cells, the instructions tell the cells to grow and multiply at a set rate. The cells die at a set time. In cancer cells, the changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes there to be too many cells. The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. Most pancreatic cancer begins in the cells that line the ducts of the pancreas. This type of cancer is called pancreatic ductal adenocarcinoma or pancreatic exocrine cancer. Less often, cancer can form in the hormone-producing cells or the neuroendocrine cells of the pancreas. These types of cancer are called pancreatic neuroendocrine tumors or pancreatic endocrine cancer. Risk factors Factors that might raise the risk of pancreatic cancer include: Smoking. Type 2 diabetes. Chronic inflammation of the pancreas, called pancreatitis. Family history of DNA changes that can increase cancer risk. These include changes in the BRCA2 gene, Lynch syndrome and familial atypical multiple mole melanoma (FAMMM) syndrome. Family history of pancreatic cancer. Obesity. Older age. Most people with pancreatic cancer are over 65. Drinking a lot of alcohol. As pancreatic cancer progresses, it can cause complications such as: Weight loss. People with pancreatic cancer might lose weight as the cancer uses more of the body's energy. Nausea and vomiting caused by cancer treatments or a cancer pressing on the stomach might make it hard to eat. Sometimes the body has trouble getting nutrients from food because the pancreas isn't making enough digestive juices. Jaundice. Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellowing of the skin and the whites of the eyes. Jaundice can cause dark-colored urine and pale-colored stools. Jaundice often occurs without belly pain. If the bile duct is blocked, a plastic or metal tube called a stent can be put inside it. The stent helps hold the bile duct open. This is done using a procedure called endoscopic retrograde cholangiopancreatography, also called ERCP. During ERCP, a health care professional puts a long tube with a tiny camera, called an endoscope, down the throat. The tube goes through the stomach and into the upper part of the small intestine. The health professional puts a dye into the pancreatic ducts and bile ducts through a small tube that fits through the endoscope. The dye helps the ducts show up on imaging tests. The health professional uses those images to place a stent at the right spot in the duct to help hold it open. Pain. A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. Treatments, such as radiation and chemotherapy, might help slow tumor growth and provide some pain relief. When medicines aren't helping, a health care professional might suggest a celiac plexus block. This procedure uses a needle to put alcohol into the nerves that control pain in the belly. The alcohol stops the nerves from sending pain signals to the brain. Bowel blockage. Pancreatic cancer can grow into or press on the first part of the small intestine, called the duodenum. This can block the flow of digested food from the stomach into the intestines. A health care professional might suggest putting a tube called a stent in the small intestine to hold it open. Sometimes, it might help to have surgery to place a feeding tube. Or surgery can attach the stomach to a lower part of the intestines where the cancer isn't causing a blockage. Prevention Screening for people with a high risk of pancreatic cancer Screening uses tests to look for signs of pancreatic cancer in people who don't have symptoms. It might be an option if you have a very high risk of pancreatic cancer. Your risk might be high if you have a strong family history of pancreatic cancer or if you have an inherited DNA change that increases the risk of cancer. Pancreatic cancer screening might involve imaging tests, such as MRI and ultrasound. These tests are generally repeated every year. The goal of screening is to find pancreatic cancer when it's small and most likely to be cured. Research is ongoing, so it's not yet clear whether screening can lower the risk of dying of pancreatic cancer. There are risks to screening. This includes the chance of finding something that requires surgery but later turns out to not be cancer. Talk about the benefits and risks of pancreatic cancer screening with your health care team. Together you can decide whether screening is right for you. Genetic testing for cancer risk If you have a family history of pancreatic cancer, discuss it with a health care professional. The health professional can review your family history and help you understand whether genetic testing might be right for you. Genetic testing can find DNA changes that run in families and increase the risk of cancer. If you're interested in genetic testing, you might be referred to a genetic counselor or other health care professional trained in genetics. Ways to lower risk You might reduce your risk of pancreatic cancer if you: Stop smoking. If you smoke, talk to a member of your health care team about ways to help you stop. These might include support groups, medicines and nicotine replacement therapy. Maintain a healthy weight. If you are at a healthy weight, work to maintain it. If you need to lose weight, aim for a slow, steady weight loss of 1 to 2 pounds (0.5 to 1 kilogram) a week. To help you lose weight, exercise most days of the week. Slowly increase the amount of exercise you get. Choose a diet rich in vegetables, fruit and whole grains with smaller portions.  (CREDITS: MAYO CLINIC)

This week we discuss diabetes mellitus, a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues. It's also the brain's main source of fuel. The main cause of diabetes varies by type. But no matter what type of diabetes you have, it can lead to excess sugar in the blood. Too much sugar in the blood can lead to serious health problems. ​Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes and gestational diabetes. Prediabetes happens when blood sugar levels are higher than normal. But the blood sugar levels aren't high enough to be called diabetes. And prediabetes can lead to diabetes unless steps are taken to prevent it. Gestational diabetes happens during pregnancy. But it may go away after the baby is born. ​​

Mast cell activation syndrome (MCAS) is when you have unexplained episodes of severe symptoms like swelling, diarrhea, vomiting, flushing and itching. Unlike allergies that happen with a specific exposure, MCAS episodes happen without a clear trigger. In some cases, mast cell activation can cause anaphylaxis, a severe allergic condition that can be life-threatening. It can cause you to have trouble breathing and drop your blood pressure to dangerously low levels. Call 911 (or your local emergency service number) or go to the nearest emergency room if you're experiencing severe anaphylaxis. Mast cells are a type of immune cell responsible for immune reactions. For instance, conditions like allergic rhinitis and asthma, allergic reactions (like anaphylaxis to drugs or food) and mastocytosis all activate mast cells. This causes them to release proteins that give you symptoms that are bothersome at best, and dangerous at worst. Other common conditions can also cause unexplained symptoms. It's important to discuss your concerns with your provider. They'll make sure you get a complete workup with a specialist, like an allergist. An allergist is a type of doctor who can diagnose and manage many types of allergic conditions. But mast cell activation syndrome is rare. Healthcare providers diagnose mast cell activation syndrome if: You have repeated symptoms of possible anaphylaxis without a clear trigger You have more than one body system affected at the same time Tests show signs of mast cell activation Mast cell medications provide relief from your symptoms (CREDITS: Cleveland Clinic)

Lung cancer is the third most common cancer in the U.S. It's caused by harmful cells in your lungs growing unchecked. Treatments include surgery, chemotherapy, immunotherapy, radiation and targeted drugs. Screening is recommended if you're at high risk. Advances in treatments have caused a significant decline in lung cancer deaths in recent years. ​ Lung cancer is a disease caused by uncontrolled cell division in your lungs. Your cells divide and make more copies of themselves as a part of their normal function. But sometimes, they get changes (mutations) that cause them to keep making more of themselves when they shouldn't. Damaged cells dividing uncontrollably create masses, or tumors, of tissue that eventually keep your organs from working properly. Lung cancer is the name for cancers that start in your lungs — usually in the airways (bronchi or bronchioles) or small air sacs (alveoli). Cancers that start in other places and move to your lungs are usually named for where they start (your healthcare provider may refer to this as cancer that's metastatic to your lungs). ​ There are many cancers that affect the lungs, but we usually use the term "lung cancer" for two main kinds: non-small cell lung cancer and small cell lung cancer.  Other types of cancer can start in or around your lungs, including lymphomas (cancer in your lymph nodes), sarcomas (cancer in your bones or soft tissue) and pleural mesothelioma (cancer in the lining of your lungs). These are treated differently and usually aren't referred to as lung cancer.  (CREDITS: Cleveland Clinic)

Did you know that about half of all eye injuries happen right at home? Home activities that can injure your eyes include: Cleaning. Chemicals like bleach in household cleaning products cause 125,000 eye injuries each year. Home Improvement. Screws, nails and hand tools can launch into the air—and into your eyes. Power tools can also send wood chips or other substances flying into the air. Yard Work. Lawn mowers, trimmers and even shovels can throw dirt and debris into the air. Branches, twigs and thorns can also be dangerous. Unfortunately, only about three out of 10 people wear protective eyewear during home projects that could hurt their eyes. The good news? Simply wearing protective eyewear can reduce your risk for eye injury by 90 percent! The American Academy of Ophthalmology urges every household to have at least one pair of ANSI-approved protective eyewear.  ("ANSI-approved" means the protective eyewear is made to meet safety standards of the American National Standards Institute.) In the house Using dangerous chemicals such as oven cleaner and bleach (accidents involving common household products cause 125,000 eye injuries each year). Read the labels of chemicals and cleaners carefully, and don't mix products. Cooking foods can that can splatter hot grease or oil. Use grease shields on frying pans to protect yourself from splattering. Opening champagne bottles during a celebration. Wrap a towel or cloth around the top of the bottle while unscrewing it to "catch" the cork. Never point a champagne bottle towards another person or yourself when opening it. Drilling or hammering screws or nails into walls or hard surfaces like brick or cement. The screws or nails can fly into the air, or fragments can come off the surface. Using hot objects such as curling irons around your face. Contact with your eyes can cause serious injury. Loose rugs and railings or other hazards that could cause falls or slips. Secure rugs with a non-slip pad underneath. Check to make sure railings are secure and not loose. Put padding on sharp corners and edges if you have children or the elderly in your house. In the yard Mowing the lawn. Check the lawn or the outdoor area first for sticks, rocks or other items that can fly out from under the mower. Using a power trimmer or edger. Clipping hedges and bushes. Playing sports. In the garage or workshop Using power or hand tools. Keep your tools in good condition; damaged tools should be repaired or replaced. Working with solvents or other chemicals. Make sure that all spray nozzles are directed away from you. Doing anything that can cause fragments or dust particles to fly around in the air. Tying down equipment or loads with bungee cords. Bungee cords are a serious danger to eyes when they snap back. For all of these activities, remember that people nearby also face serious risk. Bystanders should wear eye protection too or leave the area where the chore is being done. This is particularly important for children who watch their parents do chores in and around the home. (CREDITS: American Academy of Ophthalmology)

This week we discuss changing the outcome of your health with nutrition & exercise.  Our guest today is Dr. James Thompson, the author of Fearless Wellness and a passionate advocate for transformational change. He completed medical training 35 years ago and has dedicated my career to empowering others to live healthier, more fulfilling lives.  ​He experienced a life-changing event in 2012 and participated in a 21-day Daniel Fast with my church community. Though the three-week diet, equivalent to a whole food plant-based diet, was intended to emphasize prayer, the impact of the food intrigued him. By the end of the second week, he had more energy, fewer joint aches, more mental clarity, better sleep, and lower blood pressure. He surmised the benefits were mainly from consuming real food and omitting processed food.  He decided to take a year-long certification course in integrative holistic nutrition which was the start of his transformation to a whole food plant-based lifestyle. His training course, combined with a decade of studying nutrition science, love of animals, and concerns about climate change, has led me to the current space where he resides, a vegan. ​Here is the basic outline  & links to his Blog and his new book : "FEARLESS Wellness: Transform Your Life, One Step at a Time" F – Food: Embrace plant-based eating E – Exercise: Stay active regularly A – Avoid toxins: Eliminate harmful habits (e.g., tobacco) R – Restorative sleep: Prioritize quality rest L – Lessen stress: Manage and reduce daily pressures E – Engage your mind: Stimulate mental growth S – Social energy: Cultivate empathy and connections S – Spiritual connectivity: Foster a sense of purpose and belonging ​  

This week we discuss the dangers of impaired driving.   Impaired driving poses significant dangers, leading to thousands of fatalities and injuries each year due to reduced coordination, judgment, and reaction times. Definition and Causes Impaired driving occurs when an individual operates a vehicle while under the influence of substances such as alcohol, marijuana, prescription drugs, or illicit drugs. These substances can severely impair essential driving skills, including visual function, mental judgment, and motor skills.  Statistics Alcohol-Related Fatalities: In the United States, approximately 29 people die daily in crashes involving alcohol-impaired drivers, accounting for about 30% of all traffic-related deaths.  Drug Impairment: A significant number of drivers involved in serious crashes test positive for drugs. In a study, 51.6% of drivers involved in serious injury and fatal crashes had at least one drug in their system prior to the incident.  Effects of Impairment Alcohol: Even a single drink can impair driving abilities, leading to decreased reaction times and poor decision-making. The legal blood alcohol concentration (BAC) limit is typically set at 0.08%, but impairment can begin at lower levels.  Drugs: Both legal and illegal drugs can impair driving. For instance, marijuana can affect coordination and judgment, while stimulants like cocaine can lead to aggressive driving behaviors.  Medications: Some prescription and over-the-counter medications can cause drowsiness and dizziness, further increasing the risk of accidents.  Preventive Measures Education and Awareness: Public campaigns aimed at educating drivers about the dangers of impaired driving are crucial. Understanding the effects of substances on driving can help reduce incidents.  Designated Drivers: Encouraging the use of designated drivers, taxis, or rideshare services can significantly reduce the risk of impaired driving.  Legal Enforcement: Strict enforcement of DUI laws and sobriety checkpoints can deter impaired driving behaviors. Conclusion Impaired driving is a serious public safety issue that leads to numerous preventable deaths and injuries each year. By understanding the dangers and implementing effective preventive measures, we can work towards reducing the incidence of impaired driving and ensuring safer roads for everyone.

Falls are a threat to the health of older adults and can reduce their ability to remain independent. However, falls don't have to be inevitable as you age. You can reduce your chance of falling or help a loved one prevent falls. There are proven ways to reduce and prevent falls, even for older adults. We identify older adults as anyone 65 years and older. ​Physical changes and health conditions — and sometimes the medications used to treat those conditions — make falls more likely as you age. In fact, falls are a leading cause of injury among older adults. Still, fear of falling doesn't need to rule your life. Instead, consider six simple fall prevention strategies. ​1. Make an appointment with your health care provider Start by making an appointment with your health care provider. To assess your risk and discuss fall prevention strategies, your health care provider may want to talk about the following: Your medications. Make a list of your prescription and nonprescription medications and supplements, or bring them with you to the appointment. Your health care provider can review your medications for side effects and interactions that may increase your risk of falling. To help with fall prevention, your health care provider may consider weaning you off medications that make you tired or affect your thinking, such as sedatives, antihistamines and some types of antidepressants. Any previous falls. Write down the details, including when, where and how you fell. Be prepared to discuss instances when you almost fell but were caught by someone or managed to grab hold of something just in time. Details such as these may help your health care provider identify specific fall prevention strategies. Your health conditions. Certain eye and ear disorders may increase your risk of falls. Be prepared to discuss your health conditions and how comfortable you are when you walk — for example, do you feel any dizziness, joint pain, shortness of breath, or numbness in your feet and legs when you walk? Your health care provider may evaluate your muscle strength, balance and walking style (gait) as well. ​​2. Keep moving Physical activity can go a long way toward fall prevention. With your health care provider's OK, consider activities such as walking, water workouts or tai chi — a gentle exercise that involves slow and graceful dance-like movements. These activities reduce the risk of falls by improving strength, balance, coordination and flexibility. If you avoid physical activity because you're afraid it will make a fall more likely, tell your health care provider. Your provider may recommend carefully monitored exercise programs or refer you to a physical therapist. The physical therapist can create a custom exercise program aimed at improving your balance, flexibility and muscle strength. ​3. Wear sensible shoes Consider changing your footwear as part of your fall prevention plan. High heels, floppy slippers and shoes with slick soles can make you slip, stumble and fall. So can walking in your stocking feet. Instead, wear properly fitting, sturdy, flat shoes with nonskid soles. Sensible shoes may also reduce joint pain. ​4. Remove home hazards Take a look around your home for potential fall hazards. To make your home safer: Remove boxes, newspapers, electrical cords and phone cords from walkways. Move coffee tables, magazine racks and plant stands from high-traffic areas. Secure loose rugs with double-faced tape, tacks or a slip-resistant backing — or remove loose rugs from your home. Repair loose, wooden floorboards and carpeting right away. Store clothing, dishes, food and other necessities within easy reach. Immediately clean spilled liquids, grease or food. Use nonslip mats in your bathtub or shower. Use a bath seat, which allows you to sit while showering. ​​5. Light up your living space Keep your home brightly lit to avoid tripping on objects that are hard to see. Also: Place night lights in your bedroom, bathroom and hallways. Place a lamp within reach of your bed in case you need to get up in the middle of the night. Make clear paths to light switches that aren't near room entrances. Consider trading traditional switches for glow-in-the-dark or illuminated switches. Turn on the lights before going up or down stairs. Store flashlights in easy-to-find places in case of power outages. ​​6. Use assistive devices Your health care provider might recommend using a cane or walker to keep you steady. Other assistive devices can help, too. For example: Handrails for both sides of stairways Nonslip treads for bare-wood steps A raised toilet seat or one with armrests Grab bars for the shower or tub A sturdy plastic seat for the shower or tub — plus a hand-held shower nozzle for bathing while sitting down ​​If necessary, ask your health care provider for a referral to an occupational therapist. An occupational therapist can help you brainstorm other fall prevention strategies. Some solutions are easily installed and relatively inexpensive. Others may require professional help or a larger investment. If you're concerned about the cost, remember that an investment in fall prevention is an investment in your independence.  (credits MayoClinic)

Due to a scheduling glitch we are doing a rerun today of an episode Paris Scobie did with us earlier this year.  Paris is a Mental Health Speaker, Host of the top 1% globally ranked podcast, Live Well Bipolar, & Best-Selling Author of her memoir, Crooked Illness: Lessons From Inside & Outside Hospital Walls. Paris launched Live Well Bipolar to use her lived experience to help others overcome the shame, fear and isolation that can so often accompany living with bipolar. She shares how she went from being a patient struggling from inside the walls of a psychiatric hospital newly diagnosed with bipolar to returning to work at this same hospital years later. This unique perspective has allowed Paris to share her experiences on what truly made a difference for her to help others. Paris works to illustrate how everything she told herself she could never have or be is everything she has become today. Stay connected with Paris and learn more about her work here: https://parisscobie.com/

This week we discuss strategies autistic adults can use as employees.   Temple Grandin PhD is our distinguished guest this week.  Her website gives a great explanation of her theory on how best to prepare autistic children for a more independent life and active social integration through employment.  She emphasizes that in earlier generations, (Temple grew up in the 1950s) activities such as newspaper delivery provided young people with formative work experiences. She suggests that, in the absence of such opportunities today, parents can help children build similar skills through neighborhood jobs like dog walking or by encouraging volunteer roles in community centers and places of worship. According to Temple, these experiences cultivate discipline and responsibility, while also enhancing self-esteem through recognition of a job well done. ​ ​ ​Temple also stresses the importance of nurturing the distinctive abilities of individuals on the autism spectrum. She argues that traits such as logical reasoning, strong attention to detail, and systematic problem-solving are not only beneficial to the individual but also valuable to society as a whole. Dr. Grandin contends that efforts should focus less on seeking a "cure" for autism and more on recognizing and cultivating these cognitive strengths. In her view, neurodiverse ways of thinking play a critical role in fields such as technology and engineering, making them indispensable to future innovation.  

Bartonella is a genus of Gram-negative bacteria. It is the only genus in the family Bartonellaceae.  Facultative intracellular parasites, Bartonella species can infect healthy people, but are considered especially important as opportunistic pathogens. Bartonella species are transmitted by vectors such as fleas, sand flies, and mosquitoes.    At least eight Bartonella species or subspecies are known to infect humans.  Bartonella henselae is the organism responsible for cat scratch disease. ​History Bartonella species have been infecting humans for thousands of years, as demonstrated by Bartonella quintana DNA in a 4000-year-old tooth. The genus is named for Alberto Leonardo Barton Thompson (1871–October 26, 1950), a Peruvian scientist. ​Infection cycle Though some studies have found "no definitive evidence of transmission by a tick to a vertebrate host,"  Bartonella species are well-known to be transmissible to both animals and humans through various other vectors, such as fleas, lice, and sand flies. Bartonella bacteria are associated with cat-scratch disease, but a study in 2010 concluded, "Clinicians should be aware that ... a history of an animal scratch or bite is not necessary for disease transmission."  All current Bartonella species identified in canines are human pathogens. ​SUMMARY Bartonella is a type of bacteria that can make people very sick. There are three main kinds that cause most of the infections: B. henselae, B. quintana, and B. bacilliformis. Some of these bacteria are found all over the world (like B. henselae), but others only live in certain places (like B. bacilliformis). People can catch Bartonella in different ways: B. henselae – usually from a cat scratch or bite. B. quintana – spread by body lice. B. bacilliformis – spread by sand flies. ​​Once the bacteria get into the body, they infect red blood cells and cause the blood vessels to grow abnormally. This can lead to symptoms like long-lasting fever, swollen lymph nodes, and enlarged liver or spleen. ​Doctors figure out if someone has Bartonella using lab tests. They might grow the bacteria in a culture, look for antibodies in the blood (serology), or look at tissues under a microscope. Special tests called PCR can find Bartonella DNA in blood or tissue samples, including heart valves. ​Treatment usually involves antibiotics, but the exact medicine depends on which type of Bartonella you have and how sick you are. In some cases, like with cat-scratch disease, a doctor may need to use a needle to drain swollen lymph nodes.  

This week we are not featuring a guest, but will be discussing Haemophilus influenzae, or H. influenzae, a kind of bacteria. It can cause bacterial infections ranging from mild (such as bronchitis) to severe (such as septic arthritis). Treatment includes antibiotics but you may also require hospitalization depending on the severity of your condition. Haemophilus influenzae (H. influenzae) is a type of bacteria that can cause several different kinds of infections. These bacterial infections can range from mild, such as ear infections, to severe, such as bloodstream infections. The infections typically affect children younger than 5 years old. They also affect people who are immunocompromised, such as those with certain medical conditions. Some H. influenzae infections are "invasive," which means the bacteria invade parts of your body that are normally free from germs. For instance, H. influenzae can invade the fluid surrounding your spinal cord and brain, which can cause meningitis. Meningitis is the swelling of the lining of your brain and spinal cord. Invasive diseases usually require hospital treatment and can sometimes be fatal. (Credits: Cleveland Clinic)  

Several preventable diseases are experiencing a resurgence due to declining vaccination rates. These include:  Diphtheria: A bacterial infection that can lead to a thick membrane in the throat and respiratory failure.  Tuberculosis: A bacterial infection that can affect the lungs and other organs.  Chickenpox: A viral infection that can cause blisters and scarring.  Polio: A viral disease that can cause paralysis.  Measles: This highly contagious virus can lead to serious complications, including pneumonia and encephalitis.  Mumps: A viral infection that can cause swelling of the salivary glands and complications such as meningitis.  Rubella: A viral infection that can cause birth defects in pregnant women.  Pertussis (whooping cough): A bacterial infection that can cause severe coughing fits and respiratory problems, especially in infants.  It's important to note that these diseases can also spread among vaccinated individuals, but the vaccines significantly reduce the risk of infection and its severity.