Hey Doc,I recently returned from a ski trip to Colorado. Until this trip I only skied in West Virginia. The day after we arrived I developed a bad headache. A lodge representative suggested it might be altitude sickness. Motrin did not seem to help. It went away in a few days and no issues afterwards. Does this fit with altitude sickness, and if so, is there anything that I can do for it?Seasonal pains ~ Atlanta, Georgia——————————————————————–It could be related to the change in altitude from Atlanta to Colorado. The first question I would ask would be, where in Colorado? Altitude sickness directly relates to the amount of inspired oxygen. Using Denver, Colorado as a reference point, you would be breathing approximately an 18% concentration of inspired oxygen versus 21% at sea level. Tiny percentages make a big difference. An extreme comparison would be if one went from sea level to the top of Mount Everest where the inspired oxygen concentration is 6% or less. In this extreme case a person would lose consciousness in two minutes and die a few minutes thereafter.The body responds to altitude changes in a number of ways. Initially, a person will increase their rate and depth of breathing; activation of a protein called hypoxia-inducible factor (HIF) is also critical in turning certain metabolic processes. Blood flow to the brain increases for a period of time and maybe the culprit for attitude related headaches. Headaches along with sleep disturbance are two of the more common complaints seen among those new to higher altitudes. Altitude related headaches are usually bilateral, based in the front or side, have a dull to pressing nature, and are aggravated by activity or coughing. If related to the altitude alone by the third day these two common issues should completely resolve provided a person stays at the same altitude. There are other more serious conditions such as High Altitude Pulmonary Edema (HACE) or High-Attitude Cerebral Edema (HACE). Both of these conditions occur at very high elevations (> 4000 m). Use the links below for more information.There are several methods to prevent altitude sickness. The first is slowly ascending altitudes leaving several days in between every 1,000 meter increase in elevation. This method will work but may take up your whole trip and is not very practical. A more practical tip is to take medications that speed up acclimation to higher altitudes. Acetazolamide is a common prescription drug that can be started only a few days prior to a trip. Another type of drug is the herbal medication Ginkgo biloba. The evidence for the usage of Ginkgo is limited to a few small trials, but it has relatively safe side effect profile including pregnancy. Be aware that unlike prescription drugs, dosage per pill is not regulated. Avoiding alcohol the first night upon arrival and drinking plenty of fluids is also recommended.Helpful ReferencesInternational Society for Mountain Medicine: www.ismmed.org and Institute for Altitude Medicine: www.altitudemedicine.org.
Under the agreement, Duke will excavate more than 76 million tons of coal ash from the last open, unlined coal ash lagoons in the state, located at the Allen, Belews Creek, Cliffside, Marshall, Mayo and Roxboro sites. The ash will be moved and safely stored in lined landfills away from waterways. More than 3 million tons of non-impounded coal ash will also be excavated. At the Roxboro and Marshall facilities there will also be additional protective measures, such as surface water and groundwater monitoring, for specific sections of impoundments that will remain under existing permitted landfills or structural fills. The public will have an opportunity to comment on the coal ash lagoon closure plans at public hearings that will take place near all six of the sites in February. Duke has also agreed to enter into a court-supervised consent order with DEQ and the community groups represented by Southern Environmental Law Center in court. Duke Energy and the state of North Carolina have reached a settlement agreement requiring Duke to excavate nearly 80 million tons of coal ash at six facilities around the state. DEQ said in a press release that the excavation is the largest coal ash cleanup in the nation’s history and will result in more excavation of coal ash than in four neighboring states combined. “This agreement is a historic cleanup of coal ash pollution in North Carolina, and the Department of Environmental Quality and community groups throughout the state have provided essential leadership in obtaining it,” said Frank Holleman, senior attorney at the Southern Environmental Law Center. “The water resources and families of North Carolina will benefit from this statewide coal ash cleanup for years to come.”
continue reading » The best boards ask the best questions.That’s because they know asking probing questions leads to good ideas, says Jeff Rendel, president of Rising Above Enterprises. He addressed the CUNA National Credit Union Roundtable for Board Leadership Friday in Las Vegas.Board questions should focus mainly on “central ideas,” which serve as the credit union’s foundation, Rendel says. “Strategy derives from these ideas, and plans for execution are developed by the CEO and her team. For directors—and to remain strategic in thinking—focus on whether the ideas are sound, driven by trends, and capable of execution.”Some examples of central ideas and related questions board members should ask the CEO:• A differentiated member experience. How do you measure the member experience? What have you learned and what have you changed? What’s on the horizon for the next level of member experience, and what investments will be required? 15SHARESShareShareSharePrintMailGooglePinterestDiggRedditStumbleuponDeliciousBufferTumblr
Feb 18, 2009 (CIDRAP News) – A US Food and Drug Administration (FDA) advisory committee today recommended that pharmaceutical companies use one new influenza strain, the B component, in next season’s flu vaccine.The Vaccines and Related Biological Products Advisory Committee voted to follow the lead of the World Health Organization (WHO), which last week recommended replacing the influenza B strain in this year’s vaccine, which is from the Yamagata lineage, to one from the Victoria lineage, said Karen Reilly, an FDA spokeswoman. The WHO and the FDA panel recommended that the two influenza A strains for the Northern Hemisphere remain the same.Reilly told CIDRAP News that the votes on retaining the current influenza A/H1N1 and A/H3N2 strains were unanimous. However, the vote on changing the influenza B strain was 14 to 0 with one abstention.The flu vaccine is reformulated each year in an attempt to match ever-evolving virus strains. The WHO and FDA recommend the strains for the vaccine in February, allowing companies enough time to grow the viruses in chicken eggs and process them into vaccine doses. Most years the vaccine is protective, but last flu season all three strains in the vaccine were a poor match for circulating viruses, and the WHO and FDA recommended changing all three strains for this season.The influenza B component of this year’s flu vaccine was from the Yamagata lineage, but the proportion of strains from the Victoria lineage continues to increase and has become predominant in many countries, including the United States.The WHO and now the FDA committee recommend the following for next season’s vaccine:For the H1N1 component, a strain similar to A/Brisbane/59/2007For the H3N2 component, a strain similar to A/Brisbane/10/2007For the B component, a strain similar to B/Brisbane/60/2008-like virus, replacing B/Florida/4/2006Reilly said the committee discussed recommending the addition of a second B strain to the vaccine, but did not vote on the measure. Health officials in the United States have discussed including both lineages in the seasonal vaccine to address the unpredictable circulation of the influenza B strains, given that a vaccine against one lineage offers little protection against the other.Some of the committee members said there was not enough research yet to support adding a second B strain lineage, she said.See also:Feb 13 CIDRAP News story “WHO picks new B strain for 2009-10 flu vaccine”Jan 16 CIDRAP News story “Experts consider 4-strain flu vaccine to fight B viruses”