Cara - Cara Agar Tulang Tidak Cepat Keropos Pengeroposan tulang atau osteoporosis merupakan salah satu penyakit yang harus diwaspadai. Osteoporosis adalah jenis yang paling umum dari penyakit tulang. Osteoporosis terjadi ketika tubuh gagal untuk membentuk tulang baru yang cukup, ketika tulang tua telah terlalu banyak dihancurkan oleh tubuh. Hal ini akan mempengaruhi ketahanan dan kekuatan tubuh dalam menopang beban tubuh. Osteoporosis merupakan penipisan jaringan tulang dan hilangnya kepadatan tulang yang dapat berkembang dari waktu ke waktu. Data menyebutkan bahwa sebagian besar wanita di seluruh negara telah atau sedang mengalami osteoporosis. Bahkan di Amerika sekitar 10 juta wanita saat ini telah mengalami osteoporosis dan 34 juta wanita lainnya berisiko osteoporosis. Oleh karena semakin meningkatnya jumlah penderita, maka tidak salah apabila mulai melakukan pencegahan untuk menghindari nya. Penyebab utama osteoporosis adalah penurunan estrogen pada wanita pada saat menopause dan penurunan testosteron pada pria. Kalsium dan fosfat adalah dua mineral yang penting untuk pembentukan tulang normal. Sepanjang usia masih muda, tubuh menggunakan mineral tersebut untuk menghasilkan mineral tulang. Jika tubuh tidak mendapatkan cukup kalsium atau jika tubuh tidak menyerap kalsium yang cukup, maka produksi tulang dan jaringan tulang dapat terganggu. Ketika usia semakin tua, kalsium dan fosfat dapat diserap kembali ke dalam tubuh dari tulang, yang membuat jaringan tulang menjadi lebih lemah. Hal tersebut dapat mengakibatkan tulang rapuh, sehingga lebih rentan terhadap patah tulang, bahkan tanpa cedera sekalipun. Para ahli telah melakukan berbagai penelitian untuk menemukan beberapa cara yang efektif untuk mencegah timbulnya osteoporosis. Menurut Dr. Daemon Jones seperti dikutip detikhealth dari HealthNews menyebutkan bahwa Pertahanan dan pencegahan terbaik dari osteoporosis adalah untuk menciptakan dan mempertahankan tulang yang kuat padat Hal-hal yang bisa dilakukan untuk mencegah osteoporosis seperti dikutip dari detikhealth yaitu : 1. Menjaga kebugaran 2. Diet sehat 3. Suplemen 4. asupan dan pola makan yang baik dan sehat Berikut tips untuk menjaga agar tulang menjadi kuat tidak cepat keropos. 1. Jaga Tubuh dan Kesehatan dari sekarang sebagai investasi hidup anda di Hari Tua 2. Perbanyak Vitamin D Untuk menjaga agar tulang tetap sehat dan kuat, harus memperbanyak makanan yang tinggi kalsium dan vitamin D. Makanan yang mengandung vitamin D diantaranya adalah sayuran berwarna hijau tua, brokoli, sarden, ikan salmon, kerang serta susu 3. Kurangi Makanan Mengandung Padi-Padian Karena didalam makanan yang mengandung padi-padian mampu mengikat kalsium dan mencegah kelancaran penyerapan didalam tulang. 4. Usahakan Mengkonsumsi Bawang Karena dalam bawang dan garlic mengandung banyak belerang yang sangat baik untuk kesehatan tulang. 5. Kurangi Soft Drink Karena minuman ini banyak mengandung fosfat. Makanan atau minuman yang mengandung fosfat membuat tubuh kita mengeluarkan kalsium 6. Hindari Makanan Dengan Protein Tinggi Makanan yang memiliki kandungan protein tinggi menyebabkan kalsium menguap dari dalam tubuh 7. Kurangi konsumsi kafein Untuk menjaga agar tulang tetap sehat dan kuat, sebaiknya mengurangi konsumsi kafein yang biasanya terdapat dalam kopi. 8. Olah Raga Teratur Disamping asupan makanan yang dianjurkan, olahraga bisa menyehatkan dan menguatkan tulang. Untuk mencegah osteoporosis SehatHerbal menyediakan produk Rosella PT Dr.Liza yang tersedia dalam kemasan kapsul, teh seduh & teh celup. Rosella berkhasiat membantu memelihara kesehatan kulit, mencegah osteoporosis, memperlambat proses penuaan & menopose, mengurangi dampak negative nikotin & mencegah penuaan dini. Sumber : www.wolipop.com, www.detikhealth.com

A Late Summer Harvest

It's been a good year for gardening in Seattle, at least in my garden.  Thanks to great new tools* and Steve Solomon's recipe for homemade fertilizer, my house has been swimming in home-grown vegetables all summer.  I'm fortunate that a friend lets me garden a 300 square foot plot behind her house.  Here's a photo of part of today's harvest; various kale/collards, zucchini, tomatoes and the last of the pole beans:

Perfect for the Eocene diet.  

Read more »

Kunyit Perkuat Sistem Kekebalan TubuhPenulis : Bramirus Mikail | Selasa, 29 Mei 2012 | 09:48 WIB

KOMPAS.com - Kunyit yang selama ini kita kenal sebagai bumbu masakan ternyata menyimpan manfaat luar biasa bagi kesehatan. Sebuah riset kembali menemukan manfaat konsumsi kari (kunyit sebagai bumbu utama) dalam membantu mencegah infeksi baru dengan memperkuat sistem kekebalan tubuh. Para ilmuwan mengklaim bahwa senyawa yang ditemukan dalam kunyit dapat membantu meningkatkan kadar cathelicidin antimikroba peptida atau CAMP protein yang membantu sistem kekebalan tubuh melawan berbagai bakteri, virus atau jamur. Seperti diketahui, kunyit merupakan rempah-rempah yang umum ditemukan di Asia dan telah digunakan selama 2.500 tahun dalam pengobatan tradisional India Ayurveda. Penelitian sebelumnya telah menemukan bahwa vitamin D juga dapat meningkatkan kadar CAMP protein. Namun perbedaannya, kadar tinggi vitamin D dalam tubuh bisa menjadi racun dan dapat menyebabkan lebih banyak kalsium yang dilepas dalam darah sehingga menyebabkan hypercalcemia - yang dapat menyebabkan gejala seperti, tidak nafsu makan, mual, dan muntah. Peneliti mengatakan bahwa hasil temuan ini bisa menjadi jalan bagi penelitian baru di bidang nutrisi dan farmakologi. "Penelitian ini menjadi jalan baru untuk mengatur ekspresi gen CAMP," kata Adrian Gombart, seorang profesor biokimia dan biofisika di Linus Pauling Institute, Cornvallis, Oregon yang mempublikasikan temuan ini dalam Journal of Nutritional Biochemistry.. "Sungguh menarik dan agak mengejutkan bahwa kurkumin bisa melakukan itu dan ini dapat menjadi pilihan alternatif untuk mengembangkan terapi medis," tambahnya. Gombart dan tim juga membandingkan efektivitas kurkumin dan omega-3 asam lemak dalam meningkatkan ekspresi gen CAMP. Hasilnya menunjukkan, asam lemak omega-3 tampaknya tidak berguna dalam meningkatkan protein. Sementara percobaan laboratorium menunjukkan, kurkumin pada kunyit memiliki kemampuan hampir tiga kali lipat mendongkrak kadar CAMP pada sel manusia. "Kurkumin sebagai bagian dari kunyit, umumnya dikonsumsi dalam makanan pada tingkat yang cukup rendah," kata Gombart. "Namun, dengan konsumsi secara berkelanjutan dari waktu ke waktu seseorang bisa menjadi sehat dan membantu melindungi terhadap infeksi, terutama pada lambung dan usus," tambahnya. Kurkumin, yang dikenal memiliki sifat anti-inflamasi dan antioksidan, saat ini juga sedang dipelajari oleh para ilmuwan di Inggris sebagai suatu senyawa yang efektif untuk melawan kanker. Peneliti berharap, kurkumin dapat meningkatkan keberhasilan kemoterapi dan mengurangi efek samping. "Kami telah menunjukkan bahwa kurkumin memiliki lebih dari 100 cara untuk merusak sel kanker, khususnya sel kanker di usus besar," kata Profesor Will Stewart dari England Universitas di Leicester. "Salah satu mekanisme utama yang mempengaruhi cara kerja mereka (kurkumin) adalah bahwa mereka tumbuh di pembuluh darah," tambah Stewart. Sumber : www.medicaldaily.com Editor : Asep Candra

Was EPIC successful in watering down the Meaningful Use Stage 2 Final Rule?

At my Aug. 31, 2012 post "Health IT Vendor EPIC Caught Red-Handed: Ghostwriting And Using Customers as Stealth Lobbyists - Did ONC Ignore This?" I wrote that healthcare IT vendor EPIC was advising customers in what to write in their "Public comments" regarding the proposed Meaningful Use Stage 2 Final Rule, the requirements of which permit financial incentives to be received by a user if met by an EHR.

It appears they may have been successful.

Note their apparent boilerplate "recommendations" regarding § 170.314(a)(9) - Electronic notes.  This comes from the numerous filings with the accidentally unredacted "Informational Comments for Organizations Using Epic (remove before submitting to ONC)" note, and others without.   Pay specific attention to the "Tertiary Recommendation":

Major Concern

As detailed in our introduction, we are significantly concerned that the scope of the certification program is endangering some of the goals of Meaningful Use by introducing unnecessary overhead and burden.

As electronic notes are not proposed as a Meaningful Use objective with the rationale that electronic notes are already in common use, we do not think certification on this criterion is necessary, and suggest removal. Introducing unnecessary certification criteria creates expense for ONC, certifying bodies, and EHR developers, and does not provide significant value to the marketplace.

Recommendation
Keep consistent with CMS and remove this criterion from the Final Rule.

Secondary Recommendation
If this criterion is retained in the Final Rule, we suggest that the criterion should be an optional certification for the same reasons, and we make the following suggestions:

We agree with your assessment that having notes be searchable provides increased value over notes that are part of a scan or other formats that are not able to be searched. Our experience shows that note search capabilities is complex with potential for innovation in how information is found and displayed. Prioritization of such capabilities is best left to the marketplace. Search is not essential to meet the not-proposed objective drafted by CMS. Focus certification on the minimum floor set of capabilities required to complete meaningful use objectives. Therefore, we suggest that search capabilities be excluded from certification.

Tertiary Recommendation
If this criterion is retained in the Final Rule and is not made optional, a reasonable requirement for certification would be the ability to search for a free-text string within a particular open note. Other search capabilities should be left as competitive differentiators within the marketplace. Specific certification requirements could interrupt innovative ways to do effective chart search and information display.

Informational Comments for Organizations Using Epic (remove before submitting to ONC)

We’ve heard your requests for a chart search feature, and our desire to see this certification criterion removed does not mean we don’t want to develop such a feature. In a future version of Epic, we want to develop the best possible chart search feature based on your input. However, if this criterion stays in the Final Rule, we worry we’ll have to divert attention from future chart search features you’ve requested to focus on a simplified, less valuable version of the feature to meet certification.

Our comments [presumably, those above - ed.] stem from the fact that we believe that you prefer we focus our attention on the more sophisticated chart search feature you have requested in a future version.

The ability to search for a free-text string within an already open [on-screen] note is not of very much value (near useless perhaps?) compared to the ability to search an open patient's record for all notes that contain a string, or across a set of many records, for free-text strings or other values. Think Windows 7 "Search programs and files" at the Start menu, the MS Win XP add-on Windows Search 4.0 for Windows XP, or MacOS's Spotlight.

(Is there, I ask, a commercial EHR that cannot search for a free-text string within a "particular open note"?  Further, any web browser can search screen contents for text strings, I add, so if the EHR is using a browser, that feature comes as a freebie.)

Now note from the MU Stage 2 NPRM (Proposed Rule as in the Notice of Proposed Rulemaking) that appeared in the Federal Register on Mar. 7, 2012.  The relevant passage about note searching is highlighted in green:

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
45 CFR Part 170
RIN 0991-AB82
Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology
AGENCY: Office of the National Coordinator for Health Information Technology (ONC), Department of Health and Human Services.
ACTION: Proposed rule.

§ 170.314(a)(9) - Electronic notes

• Electronic notes

MU Objective Record electronic notes in patient records.

2014 Edition EHR Certification Criterion § 170.314(a)(9) (Electronic notes)

The HITSC recommended a certification criterion similar to the 2014 Edition EHR certification criterion we propose at § 170.314(a)(9) (with specific reference to "physician, physician assistant, or nurse practitioner" electronic notes) to support the MU objective and measure recommended by the HITPC. CMS has not proposed the MU objective and measure for Stage 2, but has requested public comment on whether the objective and measure should be incorporated into Stage 2.

Consistent with our discussion in the preamble section titled "Explanation and Revision of Terms Used in Certification Criteria," we have replaced the terms "modify" and "retrieve" in the recommended criterion with "change" and "access," respectively. Additionally, we are providing the following clarifications for the electronic "search" capability. "Search" means the ability to search free text and data fields of electronic notes. It also means the ability to search the notes that any licensed health care professional has included within the EHR technology, including the ability to search for information across separate notes rather than just within notes. We believe that this certification criterion would encompass the necessary capabilities to support the performance of the MU objective and measure as discussed in the MU Stage 2 proposed rule.

Note the robust "search" capability proposed - the ability to search the notes that any licensed health care professional has included within the EHR technology, including the ability to search for information across separate notes rather than just within notes.

Now, finally, note the Final Rule:

On pg. 300 of final rule at http://www.ofr.gov/OFRUpload/OFRData/2012-21050_PI.pdf it says:
 

Stage 2 Measures:

Enter at least one electronic progress note created, edited and signed by an eligible professional for more than 30 percent of unique patients with at least one office visit during the EHR reporting period.

Enter at least one electronic progress note created, edited and signed by an authorized provider of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) for more than 30 percent of unique patients admitted to the eligible hospital or CAH's inpatient or emergency department during the EHR reporting period.

Electronic progress notes must be text-searchable. Nonsearchable notes do not qualify, but this does not mean that all of the content has to be character text. Drawings and other content can be included with searchable text notes under this measure.

pg. 553:

Enter at least one electronic progress note created, edited, and signed by an eligible professional for more than 30 percent of unique patients with at least one office visit during the EHR reporting period.

Enter at least one electronic progress note created, edited and signed by an authorized provider of the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) for more than 30 percent of unique patients admitted to the eligible hospital or CAH’s inpatient or emergency department during the EHR reporting period.

Electronic progress notes must be text-searchable. Nonsearchable notes do not qualify, but this does not mean that all of the content has to be character text. Drawings and other content can be included with searchable notes under this measure.

It would appear, and readers, please correct me if I am mistaken, that the very short criteria specified here - "Electronic progress notes must be text-searchable" - would be satisfied by "the ability to search for a free-text string within a particular open note" per the vendor-authored Tertiary Recommendation, shown supra.

I've searched the MU Stage 2 Final Rule (Adobe Acrobat can do that, but I probably could have used Windows search itself depending on document length) seeking terms from the NPRM such as "search", "information across", "notes", "free-text" etc.  However, I cannot find anything approaching the NPRM § 170.314(a)(9) clarification regarding the meaning of "electronic search capability."

I ask:  what was the role of the Tertiary Recommendation received by ONC from multiple EPIC user organizations?

-- SS

Realizing EHR potential, or avoiding patient endangerment?

I noted an interesting comment posted in the comment thread of Bob Wachter's post "Putting the “A” Back in SOAP Notes: Time to Tackle An Epic Problem."

The comment by Dr. Christine Sinsky reads (there seems to be no way to link directly to it):

Great post Bob.  Ambulatory records are equally in need of brevity and clarity. These notes are often 6 pages of mostly nonsensical boiler plate, formatted on a billing template, leaving the reader asking your question: “but what is going on with the patient?”

After 10 years with our clinic’s EHR (McKesson HAC) and 9 years with our hospital EHR (Cerner), the most important issues I’ve encountered have been

• The time costs of data acquisition: Remember the graphic on a clipboard at the foot of the bed? It was a concise and convenient source of information that has not been reproduced in our EHR. It is now a laborious process to unearth this same information. I/Os and daily weights have become lost data points.

• The time costs of data input: One night on call I did a time trial on six of my admissions: it took an average of 73 seconds to record the admitting orders on paper vs 17 minutes to enter the same orders electronically. And in the electronic world I find myself at higher risk of forgetting the orders I meant to write, as the rigid sequence mandated by the EHR is not always the logical clinical sequence in my mind, and it requires parking orders in my mind until I finish marching through laborious tick boxes.

• Diminished situational awareness. Nurses, doctors and others have a more myopic view of the patient, as it is harder to see trends and to see the big picture. Nurses may only know the meds and the orders that pertain to their shift for example.

• Barriers to synthesis: I find it harder to synthesize the diverse sources of data for a patient when each data bit is tucked away in hard to reach electronic silos, often down long navigational pathways. Sometimes one has to scroll both vertically and horizontally (without freeze frames, so the column and row headings disappear while you scroll) creating a cognitive nightmare.

EHRs will continue to be an important tool going forward; improved usability and a better alignment with clinical workflows are needed if we are to fully realize their potential.

I thought the bullet list not at all surprising, and added the following comment in reply to amplify an implied but unstated point:

Re: “EHRs will continue to be an important tool going forward; improved usability and a better alignment with clinical workflows are needed if we are to fully realize their potential.”

You just described what could indisputably be called serious impediments to care. 73 seconds to 17 minutes? Loss of easily accessed data on I/O and daily weights? Diminished situational awareness?

Perhaps it’s time clinicians stopped sugar coating their statements with PC [politically correct - ed.] niceties such as "... if we are to fully realize their potential”, and were more forceful with a more apt “improved usability and a better alignment with clinical workflows are needed if we are to avoid patient endangerment.”

Disruptive effects like these, in my view, lend more import towards speaking of the latter than of the former.

-- SS

Who Really Makes Brand-Name Pharmaceuticals?

A striking illustration of the hazards to patients' and the public's health from health care organizational leaders using fashionable management techniques to maximize short-term revenue appeared in Reuters. 

Background: The Contaminated Heparin from China

The particular issue got public notice after US patients started to get sick and die after being infused with heparin, the common anti-coagulant drug. As we have discussed repeatedly starting in 2008 (look here, and see the summary at the end of the post), Baxter International was selling contaminated heparin under its label which was made in unregulated workshops in China, and then transmitted through a complex chain of Chinese and US companies.  What helped to further obscure the problem was what Baxter was buying was called the active pharmaceutical ingredient (API), which actualy means it was buying the active drug from poorly documented foreign sources.  In other words, it had entirely outsourced the manufacturing of a drug it sold as if it had been made by Baxter in the US.

Continued Outsourcing to Questionable Drug Manufacturers

Reuters reported on a new investigation of outsourcing of drug manufacturing to China.  The main point was:

Four years ago, Beijing promised to clean up its act following the deaths of at least 149 Americans who received contaminated Chinese supplies of the blood-thinner heparin. But an examination by Reuters has found that unregulated Chinese chemical companies making active pharmaceutical ingredients (API) are still selling their products on the open market with few or no checks.

Interviews with more than a dozen API producers and brokers indicate drug ingredients are entering the global supply chain after being made with no oversight from China's State Food and Drug Administration (SFDA), and with no Good Manufacturing Practice (GMP) certification, an internationally recognized standard of quality assurance.

'There is falsification of APIs going on, we know it,' said Lembit Rago, coordinator for Quality Assurance and Safety in Medicines with the World Health Organisation (WHO).

In fact, the article made the point that the majority of drugs sold worldwide are the product of outsourced, often unregulated, and potentially contaminated and adulterated manufacturing:

'Illegal ingredients in bulk are a big problem, but nobody talks about it,' said Guy Villax, chief executive of Hovione, an API supplier based in Portugal with factories there and in China, the United States and Ireland.

About 70 to 80 percent of all active drug ingredients - the biologically active component in medicines - originate in China and India, estimate industry experts, with China accounting for the lion's share. Its export market in these products is worth $22 billion in annual sales, according to the China Chamber of Commerce for Import and Export of Medicines and Health Products.

'If China for some reason decided to stop exporting APIs, within three months all our pharmacies would be empty,' said Villax.

How Dodgy Manufacturers Continue to Operate

Apparently, a particular problem in China is that APIs, that is, the particular drugs in question, can be made by chemical as opposed to officially designated "pharmaceutical" companies, and these chemical companies are not regulated,

A key regulatory weakness in China is the distinction between pharmaceutical and chemical companies. While the former are regulated by the SFDA, the latter, making everything from sweeteners to solvents, are not. Yet many chemical companies also churn out drug ingredients, exploiting a loophole by describing the products as chemicals, which they are, rather than the more specific designation of APIs.

For example, the article recounted how an unregulated chemical company was apparently a source for a well-known branded pharmaceutical sold by two big pharmaceutical companies headquartered in developed countries,

[A]company, Jinan Hongfangde Pharmatech (JHP), of Jinan city in Shandong province, had a product list showing at least five patented products for sale. They included tiotropium bromide, a blockbuster lung drug co-promoted by Boehringer-Ingelheim and Pfizer Inc and sold under the name Spiriva,...

Both Boehringer-Ingelheim and Pfizer spokespeople claimed that they only bought drugs from known sources, but then it would be pointless for Jinan Hongfangde Pharmatech to manufacture tiotropium bromide.

The Use of Brokers

More questions were raised by the pharmaceutical company's apparently common practice of buying drugs through brokers,

The rise of the Internet has facilitated exports of drug ingredients. An online search brings up websites offering hundreds of Chinese API sellers. Those not GMP-certified or SFDA-registered are not necessarily substandard, but buyers lack independent quality assurance.

The pervasive presence of brokers in the supply line is another risk. Pharmaceutical companies looking to source APIs in China typically hire middlemen to help them navigate the language, red tape and protocol. That system helps Chinese companies making substandard APIs avoid detection.

The reason corporate executives choose to buy drugs in China rather than having their companies manufacture them themselves seems to be to reduce costs. A post on the In-Pharma blog quoted Lembit Rago, the same WHO official quoted by Reuters, thus,

There are Chinese manufacturers supplying APIs of high quality to multinational companies, but there are also companies producing APIs of poor or not defined quality.

So,

As long as there are customers for substandard APIs they will be produced and sold.

The cheapest Chinese drugs, of course, come from the most questionable manufacturers, and that may not be apparent to companies who use brokers to facilitate purchases.

'Any number of foreign pharmaceutical companies go no further than looking for API suppliers at CPhI (an international pharmaceutical fair) based only on price,' [manaing director of Samsara Biopharma Consulting Robert] Walsh said.

Reuters spoke to brokers who said an API made by an unregulated chemical company would cost less than one from a company that had a GMP certificate.

'Different (API) grades have different prices. Sometimes we accept an order sheet and we happen to find a factory that can do it cheaper than our factory, we will outsource to them and make a bigger margin,' said one broker based in China who sources for a South African outsourcing firm.

In China there are few legal repercussions for broker firms who relabel or misrepresent products, and tracing counterfeit and substandard APIs is extremely difficult.

'There are a lot of brokers who are relabeling (APIs) which means you can't trace where the API comes from and that adds to the risk,' said the WHO's quality assurance expert Rago.

Andre, the Belgian drug detective, estimates he has uncovered fraud or misrepresentations in as many as 25 percent of cases where he has been hired to audit factories all over China. 'If you can substitute an API that is expensive to make and manufactured at a high level with something that costs much less, then that can happen,' Andre said. 'It's impossible to give an exact number, but it's not rare. It's a minority, but not tiny minority.'

Use of Substandard Raw Materials

Meanwhile, a post on PharmaLot suggested that the supposedly regulated Chinese "pharmaceutical" companies may implement questionable manufacturing practices,

A subsidiary of the Joincare Pharmaceutical Group reportedly used reprocessed cooking oil – otherwise known as ‘gutter’ oil – to make a widely used antibiotic in China. If the term gutter oil is unfamiliar, this refers to reprocessed oil made from kitchen waste dredged from gutters behind restaurants. The State Food and Drug Administration is now investigating the charge after media reports over the past several days, China Daily reports.

Why might gutter oil be purchased to produce antibiotics? The oil is cheaper than the more expensive soybean oil used to make 7-aminocephalosporinic acid, or 7-ACA, a chemical for produce cephalosporins. Joincare produces 25 percent of the total amount of the chemical, although up to a dozen other drugmakers may have purchased gutter oil from various suppliers, according to various Chinese media reports. For its part, Joincare reportedly denied using gutter oil.

The companies reportedly bought the recycled cooking oil from a company called Huikang Grease Co., which is facing prosecution over its alleged processing and selling of thousands of tons of gutter oil in 2010 and 2011. The Shanghai Daily reported that Huikang received around $22.5 million for roughly 14,700 tons of gutter oil sold to Jiaozuo Joincare Biological Product, a unit of Joincare.

Summary

There is increasing evidence that a substantial proportion, probably the majority of drugs sold by big pharmaceutical companies based in developed countries were actually made by often poorly regulated firms based elsewhere, often China or India. To put it more directly, most so called pharmaceutical companies in the US and other developed countries have outsourced the actual manufacturing of drugs. Thus, most companies that appear to be pharmaceutical manufacturing companies are really just pharmaceutical marketing and development companies. (And not so much the latter, look here:  Light DW, Lexchin JR. Pharmaceutical R&D; what do we get for all that money? Brit Med J 2012; 345: 22-25.  Link here.) Pharmaceutical companies appear to be abandoning their core essence, but are content to market drugs  under their logos without telling the patients who take them the real source of these products.  This would appear to be a big scandal, but one that stays curiously anechoic.

I have yet to see any discussion with pharmaceutical executives about why their companies hardly make drugs anymore. In the absence of such discussion, I can only speculate that most likely, this is first a product of financialization. Drug company executives, like most organizational leaders, have fallen under the spell that says their only goal should be to increase short-term revenues. It may be cheaper to buy drugs from perhaps dodgy outsourced suppliers rather than manufacturing them them themselves. Continuing stories like those above, and that of the contaminated Chinese heparin suggest that these outsourced drugs are cheap for a reason. It appears that to save money short-term, pharmaceutical executives may be abandoning their most central mission, to provide pure, unadulterated drugs.

The continuing story of outsourced pharmaceutical manufacturing provides yet more evidence that current management dogma may be literally toxic. Once again, I suggest that true health care reform requires leadership of health care organization who put patients' and the public's health ahead of short-term revenue (and the personal enrichment that may result).

It is likely that a number of policy changes will be needed to reduce the threats posed by contaminated or adulterated outsourced pharmaceuticals.  There is one simple step that ought to be taken quickly to at least make the problem more transparent.  In the US, most manufactured products have a label disclosing the country of origin.  In parallel with that, all pharmaceutical containers, and all pharmaceutical labels and marketing materials ought to disclose the country in which the active pharmaceutical ingredient was manufactured, and the name and location of the company responsible for that manufacture. 


Appendix - Heparin Case Summary

- We have posted several times, recently here about the tragic case of suddenly allergenic heparin. Although heparin, an intravenous biologic anti-coagulant, has been in use for over 70 years, serious allergic reactions to it had heretofore been rare. Starting late in 2007, hundreds of such reactions, and 21 deaths were reported in the US after intravenous heparin infusions.All the heparin related to these events in the US was made by Baxter International.

- We then learned that although the heparin carried the Baxter label, it was not really made by Baxter. The company had outsourced production of the active ingredient to a long, and ultimately mysterious supply chain. Baxter got the active ingredient from a US company, Scientific Protein Laboratories LLC, which in turn obtained it from a factory in China operated by Changzhou SPL, which in turn was owned by Scientific Protein Laboratories and by Changzhou Techpool Pharmaceutical Co. Changzhou SPL, in turn, got it from several consolidators or wholesalers, who in turn got it from numerous small, unidentified "workshops," which seemed to produce the product in often primitive and unsanitary conditions. None of the stops in the Chinese supply chain had apparently been inspected by the US Food and Drug Administration nor its Chinese counterpart. (See posts here and here.)

- We found out that the Baxter International labelled heparin was contaminated with over-sulfated chondroitin sulfate, a substance not found in nature, but which mimics heparin according to the simple laboratory tests used in the Chinese facilities to check incoming heparin. (See post here.) Further testing revealed that the contamination seemed to have taken place in China prior to the provision of the heparin to Changzhou SPL. (See post here.) It is not clear whether Baxter International or Scientific Protein Laboratories had inspected most of the steps in the supply chain, or even knew what went on there.

- The Baxter and Scientific Protein Laboratories CEOs did not seem aware of where they got the heparin on which the Baxter International label was eventually affixed. But one report in the New York Times alleged that Scientific Protein Laboratories would not pay enough for heparin to satisfy any sources other than the small "workshops."

- Leaders of all organizations involved, Baxter International, Scientific Protein Laboratories, Changzhou SPL, the Chinese government, and the US Food and Drug Administration, and the US Congress assigned blame to each other, but none took individual or organizational responsibility. (See post here.)  Note that SPL was recently bought out and taken private, making its current leadership even less transparent (see post here).  A 2010 inspection of an SPL facility by the FDA revealed ongoing manufacturing problems (see post here).

- Researchers (who turned out to have financial ties to a company which is developing an anti-coagulant drug that could compete with the heparin made by Baxter International) investigated the biological mechanisms by which the contamination of the heparin lead to adverse effects, but no one investigated further how the contamination occurred, or who was responsible. (See post here.)

- Hundreds of lawsuits against Baxter have now been filed, so far without resolution. (See post here.)  Efforts to make documents to be used in these cases public so far have not succeeded (see post here).

- A government report which attracted little attention warned of the dangers of pharmaceutical ingredients made in China and subject to virtually no oversight. (See post here.)

-  Despite requests from the US, the Chinese government did not investigate the production of the heparin that lead to the deaths (see post here.)

-  In February, 2011, a congressional investigation of the case was announced, but results are so far unavailable (see post here.)

-  In June, 2011, a jury returned the first verdict in a civil case about the contaminated heparin, awarding money from Baxter International and Scientific Protein Laboratories to the estate of a man who apparently died due to tainted heparin (see post here).

Obito Ingin Menghancurkan Dunia Karena RIN Mati ? (Manga 600)

Limit Komputer | Setelah beberapa hari ini menunggu keluarnya manga 600 akhirnya keluar juga. dan terungkap pula bahwa alasan obito ingin menghancurkan dunia shinobi karena RIN (teman kakashi dan obito) mati. 

Di situ terlihat obito sangat kesal karena RIN mati, sampai-sampai kakashi menampakan ekspresi yang terkejut dan menyesal. karena pada saat dulu obito menjalankan misi bersama Minato,Kakashi, dan RIN, obito tertimpa batu sampai-sampai obito terlihat tak berdaya, hingga obito pun berpesan pada kakashi "Kakashi, kutinggalkan RIN padamu".

Namun sampai Manga 600 baru ketahuan bahwa RIN sudah mati, itu sebabnya kebencian dan sakit hati di hati obito makin besar. dan berpikir Realita di dunia ini sudah tak berguna.

Dan yang mengejutkan di cerita akhir chapter 600, Madara dan Obito ikut dalam pertempuran. mungkin saja inilah detik-detik cerita akhir naruto. 

Daftar Skuad Liverpool FC Pada Musim 2012-2013

You’ll Never Walk Alone - Liverpool telah mendaftarkan nama para pemain yang akan berlaga di Premier League. Maklum, batas waktu pendaftaran pemain klub Premier League resmi ditutup pada Selasa (4/9), dimana setiap tim berhak mengajukan maksimal 25 nama. 

Dari batas maksimal tersebut, pemain berumur di bawah 21 tahun tidak termasuk dalam hitungan. Mengingat setiap klub bebas menurunkan para pemain di bawah usia tersebut sebanyak mungkin. 

Tiap klub pun diwajibkan menyertakan setidaknya delapan pesepak bola berstatus homegrown atau pemain yang telah resmi terdaftar di klub Inggris atau Wales minimal tiga tahun sebelum menginjak usia 21 tahun.

Skuad Liverpool di Premier League 2012/2013: 

Daniel Agger, Ossama Assaidi, Sebastian Coates Nion, Alexander Doni Marangon, Jose Enrique, Lucas Leiva, Jose Manuel Reina Paez, Nuri Sahin, Martin Skrtel, Luis Alberto Suarez Diaz.

Berstatus Home Grown: Joe Allen, James Lee Carragher, Joseph John Cole, Stewart Downing, Steven George Gerrard, Peter Gulacsi, Jordan Brian Henderson, Glen Johnson, Bradey Jones, Martin Kelly. 

Agger Masih Optimis Dengan Skuad Liverpool

Defender Liverpool, Daniel Agger mengaku tetap optimis dengan pencapaian The Reds musim ini, meski harus kembali melalui start yang buruk. 

Kekalahan atas West Brom Albion di laga perdana, menyusul hasil seri atas juara bertahan Manchester City, plus kembali kehilangan poin di Anfield kala menjamu Arsenal dinilai cukup mengendurkan semangat kubu Anfield

Dengan jeda kompetisi menjelang kualifikasi Piala Dunia Brasil 2014, Liverpool memang harus segera berbenah, mengingat sejumlah laga berat sudah menanti mereka.

Ditambah kegagalan Liverpool mendapatkan penyerang pengganti Andy Carroll yang dipinjamkan ke West Ham, membuat sejumlah kalangan pesimis dengan The Reds, kecuali Agger.

"Saya masih optimis dengan kualitas di skuad saat ini. Seluruh pemain harus meyakininya, karena jika tidak, mereka tidak seharusnya berada di klub seperti ini," ujar kapten timnas Denmark tersebut.

"Tidak mudah untuk memperbaiki sesuatu. Namun kami bekerja pada ide yang ditanamkan pelatih setiap hari, jadi semoga kami bisa lebih baik dalam menjalani sisa musim ini, dengan skuad yang ada." (bola.net)

10 Masjid Terindah Di dunia Terbaru

7 Masjid Tercantik Di dunia - Masjid merupakan tempat ibadah bagi kaum muslimin dan muslimat. Namun tahukah Anda? Banyak sekali rumah Allah ini yang memiliki keindahan luar biasa. Berikut ini adalah rangkumanya.

7. Baiturrahman, Bandar Aceh, IndonesiaMasjid Raya Baiturrahman adalah sebuah masjid yang berada di pusat Kota Banda Aceh. Masjid ini dahulunya merupakan masjid Kesultanan Aceh.

Sewaktu Belanda menyerang kota Banda Aceh pada tahun 1873, masjid ini dibakar, kemudian pada tahun 1875 Belanda membangun kembali sebuah masjid sebagai penggantinya.

Mesjid ini berkubah tunggal dan dapat diselesaikan pada tanggal 27 Desember 1883. Selanjutnya Mesjid ini diperluas menjadi 3 kubah pada tahun 1935. Terakhir diperluas lagi menjadi 5 kubah (1959-1968).
Masjid ini merupakan salah satu masjid yang terindah di Indonesia yang memiliki bentuk yang manis, ukiran yang menarik, halaman yang luas dan terasa sangat sejuk apabila berada di dalam ruangan masjid tersebut.

6. Taj’ul Masjid, Bhopal, India
Taj-ul-Masajid, adalah sebuah masjid yang terletak di Bhopal, India. Ini adalah salah satu mesjid terbesar di Asia. Masjid juga digunakan sebagai sebuah madrasah (sekolah Islam) di siang hari.

5. Omar Ali Saifuddin, Brunei
Sultan Omar Ali Saifuddin Mosque adalah masjid kerajaan Islam yang terletak di Bandar Seri Begawan, ibukota Kesultanan Brunei. Masjid diklasifikasikan sebagai salah satu masjid paling spektakuler di kawasan Asia Pasifik dan menjadi daya tarik utama bagi para turis. Sultan Omar Ali Saifuddin Mosque dianggap di antara orang-orang Brunei sebagai landmark dari negaranya.

4. Zahir Mosque, Kedah, Malaysia
Masjid ini dibangun pada tahun 1912, sebuah usaha yg dibiayakan Tuanku Mahmud Ibni Almarhum Sultan Tajuddin Mukarram Shah. Situs ini masjid merupakan makam dari Kedah warriors yang telah meninggal sambil mempertahankan Kedah dari Siam pada 1821. Arsitektur dari masjid ini terinspirasi oleh AZIZI Masjid di Langkat kota di utara Sumatera. Masjid ini ditingkatkan dengan lima besar utama domes melambangkan lima prinsip-prinsip Islam.

3. Masjid Al Aqsa, Jerusalem, Israel (Palestine)
Masjid Al-Aqsa (Arab: المسجد الاقصى, “Masjid yang terjauh”), juga dikenal sebagai Al-Aqsa, adalah sebuah tempat suci Islam di Kota Lama dari Yerusalem. Di masjid itu sendiri merupakan bagian dari Al-Haram ash-Sharif atau “Sacred Noble Sanctuary” (bersama-sama dengan Dome of the Rock), sebuah situs yang juga dikenal sebagai Gunung Bait dan situs tersuci situs dalam Judaisme, karena diyakini menjadi tempat Bait di Yerusalem sekali berdiri. secara luas dianggap sebagai yang ketiga tersuci situs dalam Islam, umat Islam percaya bahwa nabi Muhammad itu diangkut dari Masjidil haram di Mekah ke Al-Aqsa selama Perjalanan Malam. tradisi Islam menyatakan bahwa Muhammad memimpin doa terhadap situs ini sampai ketujuhbelas bulan setelah emigrasi, ketika Tuhan memerintahkan dia untuk berbelok ke arah Ka’aba.

 
Di Masjid Al-Aqsa pada awalnya kecil doa rumah dibangun oleh Rashidun kalif Umar, tetapi telah dibangun dan dikembangkan oleh Ummayad kalifat Abd al-Malik dan selesai oleh anaknya Al-Walid di 705 CE. Setelah gempa bumi di 746, masjid itu benar-benar hancur dan dibangun oleh Abbasid kalifat Al-Mansur di 754, dan kembali lagi oleh para penerus al-Mahdi di 780.


2. Masjid Al Nabawi, Madina, Saudi Arabia
Di Masjid Nabi (atau Masjid Nabi) (Arab: المسجد النبوي ), di Madinah, adalah yang kedua tersuci mesjid dalam Islam dan masjid terbesar kedua di dunia setelah Masjid Al-Haram di Mekkah . Ini merupakan tempat akhir dari Islam Nabi Muhammad. Masjid dianggap kedua tersuci masjid oleh kedua Syi’ah dan Sunni sedangkan Masjid Al-Aqsa di Yerusalem adalah yang ketiga tersuci.

Salah satu fitur yang paling penting dari situs yang Green Dome melalui bagian tengah masjid, di mana kubur Muhammad berada. Hal ini tidak benar-benar diketahui saat itu dibangun kubah hijau tetapi manuskrip dating ke awal abad 12 menjelaskan kubah. Hal ini dikenal sebagai Dome Nabi atau Green Dome. Islam setelah pemerintah sangat diperluas dan dihiasi it. Awal Muslim pemimpin Abu Bakr dan Umar yang dimakamkan di sebuah daerah di sekitar masjid.


1. Masjid Al Haram, Makkahm, Saudi Arabia
Al-Masjid Al-Haram (المسجد الحرام ) merupakan masjid terbesar di dunia. Terletak di kota Mekkah, ia seputar Kaaba, tempat yang muslim sambil menoleh ke arah yang menawarkan harian doa dan dianggap tempat yang holiest di Bumi oleh umat Islam. Masjid ini juga dikenal sebagai Grand Mosque.
Saat ini struktur yang mencakup wilayah 400.800 meter persegi (99,0 acres) termasuk luar dan dalam ruang doa dan dapat menampung sampai 4 juta selama ibadah haji periode, salah satu yang terbesar tahunan gatherings orang di dunia.

Sekian artikel yang bisa Espilen Blog sampaikan mengenai 7 Masjid Tercantik atau terindah di Dunia ini. Mohon maaf atas segala kekurangannya. Semoga memberikan manfaat.

Ternyata Mount Everest Bukanlah Gunung Tertinggi Di Dunia ?

You’ll Never Walk Alone - Dalam pelajaran geografi di sekolah kita sering mendapat informasi bahwa gunung tertinggi di dunia adalah gunung Everest atau Mount Everest di Nepal. Benarkah demikian? Ternyata ini tidaklah sepenuhnya benar! Apa alasannya? Kalau tidak benar, so gunung mana yang lebih tinggi dibandingkan Everest?

Sebelum kita menjawab benar atau salah, terlebih dahulu kita telaah dulu beberapa cara mengukur dan menentukan gunung tertinggi di dunia. Cara-cara tersebut adalah sbb:

1.	Pengukuran dilakukan dari atas permukaan laut (from above sea level).
2.	Pengukuran dilakukan dari dasar gunung (from its bottom/base).
3.	Pengukuran dilakukan dari pusat bumi (from the center of the earth).

Apabila cara pertama dilakukan, maka benarlah adanya bahwa Mount Everest adalah gunung tertinggi di dunia dengan ketinggian dari permukaan laut adalah 8.848 meter, disusul kemudian gunung K2 di Kashmir/Xinjiang (8.611 meter) dan tertinggi ke-3 adalah Gunung Kangchenjunga di Nepal/India (8.586 meter).

Apabila cara kedua dilakukan, maka Gunung Mauna Kea di Hawaii/USA merupakan yang tertinggi. Gunung ini menjulang dari dasar kedalaman Samudera Pasifik sepanjang 10,203 meter tetapi hanya setinggi 4.205 meter di atas permukaan laut. Dengan metode pengukuran ke dua ini Gunung Everest hanya berada di posisi ke-3 di bawah Gunung Denali (Mount McKinley) di Alaska dengan ketinggian antara 5,300-5,900 meters. Denali lebih tinggi dari Everest karena Everest berdiri di atas dataran tinggi Tibetan Plateau dengan ketinggian 5.200 meter, sehingga ketinggian dari dasar hanya 3.650 meter saja (total 8.848 meter).

Gunung Mauna Kea (Hawaii)	Gunung Chimborazo (Ecuador)

Sementara apabila cara terakhir dilakukan, maka yang tertinggi di dunia adalah Gunung Chimborazo (Ecuador) di Pegunungan Andes. Meskipun ketinggian dari atas permukaan laut hanya 6.267 meter, puncak gunung ini berjarak terjauh dari pusat bumi yaitu berjarak 6.384.404 meter, bandingkan dengan Everest yang hanya berjarak 6.381.670 meter dari pusat bumi.

Sumber

Jenis-jenis Tanaman Hias Pengusir Nyamuk

Di musim kemarau yang berkepanjangan seperti saat ini, rumah makin rentan serbuan nyamuk. Selain mengganggu tidur, nyamuk juga membawa aneka penyakit, seperti demam berdarah, chikungunya, dan malaria.
Akan tetapi, mengusir nyamuk dengan obat anti-nyamuk berbahan kimia sangat riskan, terutama bagi mereka yang memiliki anak kecil di rumah. Untuk itu, Anda dapat menggunakan beberapa tanaman yang memiliki kemampuan mengusir nyamuk. Selain aman bagi kesehatan dan lingkungan, ternyata tumbuhan ini juga indah dijadikan penghias ruangan.

Lavender

Tanaman asal Pegunungan Alpen, Swiss, ini memang sudah dikenal sebagai bahan baku lotion anti-nyamuk. Tanaman berbunga ungu ini tidak disukai nyamuk karena mengandung zat linalool dan lynalyl acetate. Untuk menghindari gigitan nyamuk, cukup gosokkan bunga lavender ke tubuh.
Tak hanya sebagai pengusir nyamuk, kandungan minyak atsiri dalam lavender juga sering digunakan untuk terapi aroma. Lavender dapat ditanam di dalam pot. Jika perlu, masukkan pot berisi lavender ke dalam kamar agar nyamuk enggan datang.

Zodia

Tanaman asli Papua ini termasuk famili Rutaceae, yang mengandung zat evodiamine dan rutaecarpine yang berfungsi sebagai penghalau nyamuk yang mampu bertahan selama 6 jam. Masyarakat Papua biasa menggosokkan daun ini pada tubuh sebelum masuk hutan untuk menghindari serangga.
Untuk menghindari serbuan nyamuk ke dalam rumah, letakkan zodia di titik akses masuknya angin ke dalam ruangan — bisa juga diletakkan dekat kipas angin. Embusan angin akan membuat aroma zodia tersebar ke seluruh ruangan dan mengusir nyamuk. Tetapi hindari meletakkan zodia di ruangan sempit dengan sirkulasi udara terbatas, karena aroma zodia bisa membuat pening.

Geranium (Pelargonium Hortorum)

Geranium alias Tapak Dara atau pelargonium, mengandung geraniol dan sitronelol yang dapat mengusir nyamuk. Tanam geranium di dalam pot dan letakkan di tempat yang terkena embusan angin. Saat daun-daun Geranium bergesekan, aromanya akan tercium dan membuat nyamuk pergi.
Sebuah penelitian menunjukkan, ekstrak geranium radula mampu menolak nyamuk aedes aegypti. Hanya dengan mengoleskan ekstrak tumbuhan ini pada bagian tubuh, nyamuk penyebab demam berdarah tersebut kabur. Hebatnya, ekstrak geranium juga tidak menimbulkan iritasi kulit.

Rosemary

Rosemary menghasilkan bau seperti aroma minyak telon yang tidak disukai nyamuk. Tamanan ini tumbuh baik di bawah sinar matahari, tetapi saat diperlukan Rosemary bisa letakkan di dekat jendela. Untuk pemanfaatannya, gosokkan daunnya yang berbentuk jarum pada kulit.

Serai

Mungkin tak banyak yang tahu jika tanaman yang sering digunakan sebagai bumbu masak ini mampu membunuh nyamuk, karena mengandung zat geraniol dan sitronelal. Lantaran kandungannya tersebut, tumbuhan yang masuk jenis rumput-rumputan ini mulai digunakan sebagai bahan lotion anti-nyamuk.

Citrosa Mosquito

Tumbuhan asal Negeri Kincir Angin ini memiliki aroma seperti lemon yang pekat sehingga tidak disukai serangga. Citrosa Mosquito sangat menyukai sinar matahari dan tidak memerlukan perawatan khusus. Tetapi tanaman ini sulit ditemukan di pasar.

Marigold (Bunga Tai Kotok)

Tumbuhan dengan bunga semarak: kuning, merah, dan jingga ini banyak ditemukan di Indonesia dan lebih dikenal dengan nama bunga tai kotok. Marigold memiliki dua jenis, yakni tagetes erecta dan tagetes patula.
Baunya yang tidak enak ternyata bisa mengusir nyamuk. Dengan bunga yang indah, tak ada salahnya jika marigold dipajang di salah satu sudut ruangan rumah.


Akar Wangi

Akar wangi dapat mengeluarkan aroma menyengat yang tidak disukai dan mampu membunuh nyamuk aedes aegypti. Ekstrak akar wangi teruji dapat mengendalikan nyamuk aedes aegypti dan anopheles aconitus. Untuk mengusir nyamuk dari rumah, tanam tumbuhan ini di pekarangan rumah dan rasakan faedahnya.