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diseases. But how did they come about? Learn about the development of these life changing treatments, as well as antibiotic resistence.",3,[36],{"id":37,"data":38,"type":25,"version":24,"maxContentLevel":34,"pages":40},"19b170b5-cbab-4068-b537-2ab53f502734",{"type":25,"title":39},"Antibiotic Resistance and the Need for New Antibiotics",[41,56],{"id":42,"data":43,"type":24,"maxContentLevel":34,"version":24,"reviews":47},"0c269148-886b-4ec7-be58-fdb9616a370f",{"type":24,"title":44,"markdownContent":45,"audioMediaId":46},"Antibiotic Resistance ","In 1940 Edward Abraham and Ernst Chain reported that an *E.coli* strain was able to inactivate penicillin by producing an active enzyme called *penicillinase*, while, in 1945, Alexander Fleming predicted that the high demand for antibiotics would introduce an “era of abuse.” Once penicillin became available by prescription, the antibiotic started to be overused and Fleming’s prediction became a reality. \n\nSince then, studies have proved the correlation between increased antibiotic use and the emergence of resistance, with each new generation of antibiotics following the same trend. To survive, germs that cause infections develop defense strategies against antibiotics called resistance mechanisms. These *resistance mechanisms* include changing or even destroying the antibiotic with enzymes that break down the drug. As a result, diseases are becoming harder or even impossible to treat.","d0840cb5-6feb-4450-9e18-536aacd636ac",[48],{"id":49,"data":50,"type":51,"version":24,"maxContentLevel":34},"e5842cba-5ba1-4bfd-8c56-a0b4eb17a2b7",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":52,"activeRecallAnswers":54},11,[53],"Why are diseases becoming more difficult to treat with antibiotics in 21st century than they were in the 20th?",[55],"Because bacteria have since developed antibiotic resistance",{"id":57,"data":58,"type":24,"maxContentLevel":34,"version":24,"reviews":62},"5528e821-f6e7-49b6-9d09-3fa0d4d39c3d",{"type":24,"title":59,"markdownContent":60,"audioMediaId":61},"The Need for New Antibiotics","Antibiotic resistance is also known as *antimicrobial resistance* or *AMR*. The World Health Organization has declared that AMR is one of the top 10 global public health threats facing humanity today, with certain infections such as pneumonia and TB becoming increasingly harder to treat. \n\nAccording to The World Health Organization, new antibiotics are urgently needed but the clinical pipeline is limited; only 32 antibiotics addressing The World Health Organization’s list of priority pathogens were identified in clinical development in 2019, of which only 6 were classified as innovative. However, if current practices in how antibiotics are prescribed and used don’t improve, any new drugs developed will also eventually become ineffective.\n\nResearch into the human gut microbiome – the community of helpful bacteria that reside within our digestive systems – has also begun to show the dangers of overuse of antibiotics. In particular, over prescription of ‘broad-spectrum’ antibiotics that indiscriminately eradicate both bad *and* good bacteria within us.","53063849-385f-4e88-a691-ca6249dfce9e",[63,74,81],{"id":64,"data":65,"type":51,"version":24,"maxContentLevel":34},"098e741c-8ddb-4a7f-9c98-ba84add3974e",{"type":51,"reviewType":34,"spacingBehaviour":24,"multiChoiceQuestion":66,"multiChoiceCorrect":68,"multiChoiceIncorrect":70},[67],"How many new antibiotics against priority pathogens were identified in 2019?",[69],"32",[71,72,73],"6","20","55",{"id":75,"data":76,"type":51,"version":24,"maxContentLevel":34},"720f801e-b68b-4838-8650-4edfe3899d18",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":77,"activeRecallAnswers":79},[78],"What are 'broad-spectrum’ antibiotics?",[80],"Antibiotics that have the ability to affect many different species of bacteria",{"id":82,"data":83,"type":51,"version":24,"maxContentLevel":34},"ee4bbf8c-1326-4d38-a22f-7024a22dfbbb",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":84,"activeRecallAnswers":86},[85],"AMR is one of the top 10 global public health threats facing humanity today. AMR stands for what?",[87],"Antimicrobial resistance",{"id":89,"data":90,"type":27,"maxContentLevel":34,"version":24,"orbs":93},"3a4a7822-268f-4460-b135-e2a3b1306941",{"type":27,"title":91,"tagline":92},"Immunology & the Development of Vaccines","Vaccines are truly amazing, learn about how they were developed, their success in eradicating diseases, and the power of immunity. ",[94,197,298],{"id":95,"data":96,"type":25,"version":24,"maxContentLevel":34,"pages":98},"675c5a48-db76-4341-9185-d90357df1284",{"type":25,"title":97},"The Evolution of Immunity",[99,124,154,182],{"id":100,"data":101,"type":24,"maxContentLevel":34,"version":24,"reviews":105},"7c2d11e7-e6a2-4d60-b09f-2be405cafaad",{"type":24,"title":102,"markdownContent":103,"audioMediaId":104},"Definition & Concept of Immunity ","The word *immunity* comes from Latin, meaning ‘free or exempt’, and was originally used in the context of ‘being exempt from performing public service.’ Its association with medicine and the meaning of ‘being exempt from disease’ didn’t come about until the late 19th century. \n\nThe *concept* of immunity from disease, however, dates back to ancient Greece in the 5th century BCE. This was a time when Athens was ravaged by the plague, killing thousands of people. During this time, Thucydides, one of the greatest ancient historians, wrote about individuals who had contracted the disease, recovered from it, and become *immune* to it. \n\n ![Graph](image://87d420d7-4e20-4c64-b0ff-ef5aa3a63444 \"Thucydides\")\n\nIt is interesting to note that, while Thucydides referred to the disease as the *plague*, the term was used in ancient times for any epidemic and, according to many scholars, most of the symptoms that he described align more closely with smallpox. \n\n\n\n","52cc0d61-b5f8-4c24-a5ab-36248e2fd5c0",[106,115],{"id":107,"data":108,"type":51,"version":24,"maxContentLevel":34},"1265cf18-c3f2-4076-8d0b-4abc1aee325f",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":109,"binaryCorrect":111,"binaryIncorrect":113},[110],"The concept of immunity from disease dates back to",[112],"5th century Greece",[114],"10th century China",{"id":116,"data":117,"type":51,"version":24,"maxContentLevel":34},"6c4c49f8-acba-4bdc-944d-1ccfef7665dd",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":118,"binaryCorrect":120,"binaryIncorrect":122},[119],"The term immunity comes from the Latin and originally meant",[121],"Exempt from performing public service",[123],"Exempt from disease",{"id":125,"data":126,"type":24,"maxContentLevel":34,"version":24,"reviews":130},"faf53139-e72c-491a-9c37-17658a627274",{"type":24,"title":127,"markdownContent":128,"audioMediaId":129},"Variolation ","While the medical concept of immunity dates back to antiquity, the earliest recorded attempt to intentionally induce immunity against an infectious disease was in 10th century China where smallpox – also known as *variola* – was prevalent at the time. Through a process known as *variolation*, healthy individuals were exposed to the disease by either inhaling powdered scabs of smallpox collected from an infected person or having the powder scratched into their skin. \n\n*Variolation* eventually became common practice in the Ottoman Empire in the late 1600s, and even became fashionable in Europe in the early 18th century. However, this form of inoculation came with a 2-3% death rate or, in some cases, disfiguration from the disease itself, so European physicians deemed it far too risky, and its use became increasingly limited.","af096929-726d-4a33-8f73-37cd346082d3",[131,138,147],{"id":132,"data":133,"type":51,"version":24,"maxContentLevel":34},"07b916aa-7842-4d4c-9b60-d54673f553d1",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":134,"activeRecallAnswers":136},[135],"What is variolation?",[137],"A process where healthy individuals were exposed to the disease by either inhaling powdered scabs of smallpox collected from an infected person or having the powder scratched into their skin.",{"id":139,"data":140,"type":51,"version":24,"maxContentLevel":34},"1a0b9169-80ce-439c-ad2f-c6a3dc696dce",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":141,"binaryCorrect":143,"binaryIncorrect":145},[142],"What is the typical mortality rate for variolation?",[144],"2-3%",[146],"5-8%",{"id":148,"data":149,"type":51,"version":24,"maxContentLevel":34},"87e19443-84eb-4777-bae3-47e549001449",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":150,"activeRecallAnswers":152},[151],"Where does the name variolation come from?",[153],"From another name for smallpox - variola",{"id":155,"data":156,"type":24,"maxContentLevel":34,"version":24,"reviews":160},"c60cb73c-ba1c-4abf-9561-761c075338ad",{"type":24,"title":157,"markdownContent":158,"audioMediaId":159},"From Variolation to Vaccination","Variolation, in other words the inhalation or skin insertion of powdered smallpox scabs, stopped being used as a method of inoculation against smallpox in the mid-18th century due to its potentially lethal side-effects. However, in 1798, British country doctor Edward Jenner noticed that milkmaids that had been infected with *cowpox* – the bovine equivalent of smallpox – were protected against smallpox. \n\nAs a result of his discovery, Jenner became the first to test this method through scientific means. He decided to inoculate an 8-year-old boy with *cowpox* pus extracted from lesions on a milkmaid’s hands and inserted the fluid into the boy’s arm. After 6 weeks, Jenner exposed the boy to smallpox and the boy did not become infected, nor did he after 20 subsequent exposures. In the years that followed, the evidence that Jenner collected was conclusive enough for the concept of *vaccination* against smallpox to be born – the word itself originating from the word *Vacca* which means cow in Latin.\n\n ![Graph](image://94f27086-6451-40ca-abf0-bd7e7dc5a16d \"A milkmaid shows her cowpoxed hand to a physician\")\n\n","93d9e394-ede7-4e10-88d8-7d228967af52",[161,168,175],{"id":162,"data":163,"type":51,"version":24,"maxContentLevel":34},"6c5156fc-4b62-49f9-9bb1-5216eb1928c1",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":164,"activeRecallAnswers":166},[165],"What happened to the 8 year old boy who had the cowpox pus extracted from lesions on a milkmaid’s hands injected into his arm?",[167],"He did not become infected by smallpox.",{"id":169,"data":170,"type":51,"version":24,"maxContentLevel":34},"8ff03283-e674-4ec7-97ea-fcbfcc581452",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":171,"activeRecallAnswers":173},[172],"What observation inspired British country doctor Edward Jenner to investigate vaccination?",[174],"The fact that the milkmaids who had been infected with cowpox – the bovine equivalent of smallpox – were protected against smallpox. ",{"id":176,"data":177,"type":51,"version":24,"maxContentLevel":34},"a5ce3f70-1be0-4765-8ac7-ee5732a120bb",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":178,"activeRecallAnswers":180},[179],"Where does the name vaccination come from?",[181],"From the Latin word for cow - vacca, as Edward Jenner was investigating immunity of milkmaids who worked with cows.",{"id":183,"data":184,"type":24,"maxContentLevel":34,"version":24,"reviews":188},"42d2feb6-71b7-49f1-9022-5abddc1d7171",{"type":24,"title":185,"markdownContent":186,"audioMediaId":187},"Expanding the Meaning of Vaccine ","In 1798, Edward Jenner was the first to develop a successful technique in creating a vaccine against smallpox. In 1885, French biologist Louis Pasteur used the same technique to save the life of a 9-year-old boy who had been bitten by a rabid dog. Pasteur injected the boy with a weakened form of the rabies virus every day for 13 days. The treatment was so successful that the boy survived and never even developed rabies. Following in his predecessor’s shoes, Pasteur had developed the ‘rabies vaccine,’ thus expanding the meaning and use of vaccines beyond their original scope. \n\nPasteur’s success influenced the medical field, leading to the development of groundbreaking treatments that produced immunity against an infectious disease. These treatments contained live, weakened viruses or killed viruses. Scientific advances in the first half the 20th century led to development of vaccines against whooping cough (1914), diphtheria (1926), tetanus (1938), and influenza (1945). Those were followed by vaccines against polio (1955), measles (1963) and rubella (1969). Thanks to their efficacy and successful global health campaigns, vaccination rates shot up dramatically.\n\n ![Graph](image://0041aa0d-67c7-4a22-9c26-0558014a7dd6 \"Drawings Showing Smallpox and Cowpox innoculations\")\n","6f514077-8a6f-4a1f-aedf-3067b2208d7f",[189],{"id":190,"data":191,"type":51,"version":24,"maxContentLevel":34},"cc3d6b22-19b6-461f-960a-c09ada9c26f7",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":192,"activeRecallAnswers":194},[193],"What was the second vaccine that was invented? Who invented it?",[195,196],"Rabies","Louis Pasteur",{"id":198,"data":199,"type":25,"version":24,"maxContentLevel":34,"pages":201},"cdda0eee-9614-46e1-b244-e3717927de4e",{"type":25,"title":200},"Mechanisms and Types of Vaccines",[202,227,276],{"id":203,"data":204,"type":24,"maxContentLevel":34,"version":24,"reviews":208},"9e6fa0b2-99f4-41c7-bf34-820928eed05d",{"type":24,"title":205,"markdownContent":206,"audioMediaId":207},"How Vaccines Work – the Technical Bit","To understand how vaccines work, it is vital to understand how the body fights illness. When germs invade the body in the form of bacteria or viruses, they attack healthy tissue and multiply, causing an infection. The white cells contained in our blood are there to fight such invasions, with the help of *B-lymphocytes* and *T-lymphocytes*. *B-lymphocytes* produce antibodies that attack the germs initially, while some *T-lymphocytes* go into action quickly if the body is attacked by the same germ again. As a result, the immune system remembers what it learned about a specific disease and is equipped to protect the body against that disease if it attacks again. \n\nVaccines work very much in the same way: by introducing the body to a very small amount of a live, weakened, or dead pathogens, they are imitating an infection and help the body build immunity against it. This type of infection almost never causes disease but will encourage the immune system to produce *T-lymphocytes* and *B-lymphocytes* to fight that disease in the future.","ba8587a7-94b1-4d93-b653-1a9e28b39901",[209,218],{"id":210,"data":211,"type":51,"version":24,"maxContentLevel":34},"98626bf3-c5cd-4d3e-a2a9-e3108c5e8fcd",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":213,"clozeWords":215},4,[214],"White cells fight bacterial or viral infections with B-lymphocytes which produce antibodies that attack the germs initially, while T-lymphocytes go into action quickly if the body is attacked by the same germ again.",[216,217],"B-lymphocytes","T-lymphocytes",{"id":219,"data":220,"type":51,"version":24,"maxContentLevel":34},"dd2bcc54-42fd-4ba2-88bb-1fa531e64a2c",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":221,"clozeWords":223},[222],"Vaccines work by introducing the body to a very small amount of a live weakened – or killed - virus, to imitate an infection and help the body build immunity against it.",[224,225,226],"live weakened","killed","imitate an infection",{"id":228,"data":229,"type":24,"maxContentLevel":34,"version":24,"reviews":233},"61c057fc-5769-4fbe-ae3c-aa6a34b99d2f",{"type":24,"title":230,"markdownContent":231,"audioMediaId":232},"Different Types of Vaccines ","According to the US Department of Health & Human Services, there are 5 types of vaccines. \n\n*Live, attenuated vaccines*, contain a weakened version of the living virus, like the MMR vaccine for measles, mumps, and rubella, while *inactivated vaccines* contain an inactivated or killed virus, like the inactivated polio vaccine. \n\nThere are also vaccines which contain only parts of a germ and not the entire bacteria or virus, like the pertussis component of the DTaP (Diptheria, Tetanus and Pertussis) vaccine – these are called *subunit vaccines*. In addition, for diseases caused by toxins, vaccines containing a weakened version of the toxin, are called *toxoid vaccines*, such as the DTaP vaccine which contains diphtheria and tetanus toxoids. \n\nFinally, *mRNA (messenger RNA)* vaccines create proteins in order to trigger an immune response to a virus. mRNA vaccines can be manufactured relatively quickly, making them very useful when fighting rapidly evolving contagious disease outbreaks like COVID-19.","177038f9-7191-4625-8910-605b5a8309de",[234,241,248,255,262,269],{"id":235,"data":236,"type":51,"version":24,"maxContentLevel":34},"056ac2f3-e70e-4982-a9f8-a4fdadccbf9b",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":237,"activeRecallAnswers":239},[238],"What are mRNA (messenger RNA) vaccines?",[240],"They create proteins in order to trigger an immune response to a virus and can be manufactured relatively quickly.",{"id":242,"data":243,"type":51,"version":24,"maxContentLevel":34},"46f4deb8-c539-4f63-8bec-70a6dff1f95a",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":244,"activeRecallAnswers":246},[245],"What are live, attenuated vaccines?",[247],"They contain a weakened version of the living virus, like the MMR vaccine for measles, mumps, and rubella.",{"id":249,"data":250,"type":51,"version":24,"maxContentLevel":34},"80c8346a-0cea-4256-9fd8-d473467d22ec",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":251,"activeRecallAnswers":253},[252],"How many types of vaccines are there?",[254],"5",{"id":256,"data":257,"type":51,"version":24,"maxContentLevel":34},"b3b4bf6e-a4ce-4634-a161-8617c0d53392",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":258,"activeRecallAnswers":260},[259],"What are subunit vaccines?",[261],"They contain only parts of a germ and not the entire bacteria or virus, like the pertussis component of the DTaP vaccine.",{"id":263,"data":264,"type":51,"version":24,"maxContentLevel":34},"e36485dc-7cc0-444a-bebc-f6c91d5414a6",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":265,"activeRecallAnswers":267},[266],"What are inactivated vaccines?",[268],"They contain an inactivated or killed virus, like the inactivated polio vaccine.",{"id":270,"data":271,"type":51,"version":24,"maxContentLevel":34},"f26b535a-6ee5-496c-bf95-427cc44b7c50",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":272,"activeRecallAnswers":274},[273],"What are toxoid vaccines?",[275],"They are vaccines for diseases caused by toxins, vaccines containing a weakened version of the toxin.",{"id":277,"data":278,"type":24,"maxContentLevel":34,"version":24,"reviews":282},"ee6040ec-4f80-4f6f-a830-6bbcac0ea330",{"type":24,"title":279,"markdownContent":280,"audioMediaId":281},"The Significance of Vaccines","Vaccines are one of the most important advances in modern medicine and have increased our quality of life by reducing or even eliminating many infectious diseases. A disease is considered *eliminated* when it stops circulating in a region, and if it is eliminated worldwide, it is then considered *eradicated*. In 1980, the World Health Assembly declared smallpox eradicated, with the last recorded case occurring in Somalia in 1977. There was a time when smallpox killed up to 35% of infected patients and, to date, it is the only human infectious disease to be eradicated. \n\nThere are 14 diseases that have been eliminated in the U.S. due to extensive vaccination programs, including polio and rubella. The same trend applies to the rest of the developed world, and, while the diseases still exist, they aren’t as threatening as they once were because vaccines have immunized the majority of those populations.","58d710ca-c82f-4973-8a8a-a27f1f9b6826",[283,291],{"id":284,"data":285,"type":51,"version":24,"maxContentLevel":34},"4b50ebc4-bbfc-45c3-a2d7-577402ea0e21",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":286,"clozeWords":288},[287],"A disease is considered eliminated when it stops circulating in a region, and if it is eliminated worldwide, it is then considered eradicated.",[289,290],"eliminated","eradicated",{"id":292,"data":293,"type":51,"version":24,"maxContentLevel":34},"a238608c-3eb7-4660-a80d-9b5efb9a74bd",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":294,"activeRecallAnswers":296},[295],"What disease was considered eradicated in 1980 by the World Health Assembly?",[297],"Smallpox",{"id":299,"data":300,"type":25,"version":24,"maxContentLevel":34,"pages":302},"96c5aeba-c5b5-4583-8342-639757934f66",{"type":25,"title":301},"Challenges and Misconceptions",[303,333],{"id":304,"data":305,"type":24,"maxContentLevel":34,"version":24,"reviews":309},"4bdf195a-9e08-4042-b934-d40581dad5ab",{"type":24,"title":306,"markdownContent":307,"audioMediaId":308},"Controversies & Misconceptions Surrounding Vaccines","Despite the fact that vaccines help prevent serious disease and unnecessary deaths, and even though they have been proven to be incredibly safe, vaccines have always been surrounded by controversy and misconceptions. Some of the most common are that vaccines have serious side-effects, that the MMR vaccine in children is linked to autism, and that children’s immune systems are overloaded with too many vaccines all at once, causing adverse effects.  \n\nHowever, none of these misconceptions and controversies are based on reliable scientific research or evidence. Quite the contrary – there have been numerous conclusive epidemiological studies proving vaccine safety. The risk, though, is that these misconceptions may lead people to become hesitant about vaccinations, which could lead to a resurgence of previously eliminated infections. As emphasized in a review of vaccine controversies published in *Clinical Infectious Disease* “concerns about vaccine safety can lead to decreased acceptance of vaccines and resurgence of vaccine-preventable diseases.”","2f1ccfbb-dc35-43c1-ab33-2043521aa36c",[310,319,326],{"id":311,"data":312,"type":51,"version":24,"maxContentLevel":34},"3ae32634-1c34-46ef-a00f-bc33c854effe",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":313,"binaryCorrect":315,"binaryIncorrect":317},[314],"Vaccines can sometimes cause autism.",[316],"False",[318],"True",{"id":320,"data":321,"type":51,"version":24,"maxContentLevel":34},"b02d757b-f10e-4977-9c50-35c204c77b76",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":322,"activeRecallAnswers":324},[323],"What is a potential consequence of misconceptions about vaccines?",[325],"That previously eliminated diseases such as polio and rubella come back to the developed world.",{"id":327,"data":328,"type":51,"version":24,"maxContentLevel":34},"ffa28eed-51e6-4abb-801b-67ceae74d60d",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":329,"activeRecallAnswers":331},[330],"How was vaccine safety established?",[332],"Through rigorous peer reviewed scientific research.",{"id":334,"data":335,"type":24,"maxContentLevel":34,"version":24,"reviews":339},"e5131d44-d819-4649-aefb-e6873f79e405",{"type":24,"title":336,"markdownContent":337,"audioMediaId":338},"The Future of Vaccines ","Vaccines have been a part of medicine’s fight against disease for over 200 years. Smallpox has been eradicated, polio has been eliminated in most countries around the world, and childhood vaccination programs in the developed world have substantially reduced mortality from infectious diseases. \n\nThere are diseases however, such as malaria and HIV/AIDS, for which scientists have been unable to create effective vaccines, so research is continuing. Also, new techniques are being developed to create different types of vaccines such as DNA vaccines and mRNA vaccines. Furthermore, researchers are looking into creating vaccines that are simpler to administer, can survive transport without refrigeration, and provide more substantial immune response.","a1a698bf-e433-4f46-aa97-0367b98752cb",[340],{"id":341,"data":342,"type":51,"version":24,"maxContentLevel":34},"10ad0357-9646-4989-824e-199f2585a968",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":343,"activeRecallAnswers":345},[344],"What are two examples of diseases for which we have not developed effective vaccines?",[346,347],"Malaria","HIV/AIDS",{"id":349,"data":350,"type":27,"maxContentLevel":34,"version":24,"orbs":353},"7f1c57a6-333f-4d3c-99bf-d6225d0b4426",{"type":27,"title":351,"tagline":352},"Germ Theory","Before the 1800s, it was not widely understood that microscopic organisms cause disease. Learn how germ theory forever changed the way we understand illnesses and the body.",[354,434,488],{"id":355,"data":356,"type":25,"version":24,"maxContentLevel":34,"pages":358},"d0ab4cd3-d2e3-4c26-afe1-1d3fa9d2b4d2",{"type":25,"title":357},"Foundations of Germ Theory",[359,389,420],{"id":360,"data":361,"type":24,"maxContentLevel":34,"version":24,"reviews":365},"dcdc0303-800d-4b99-8814-732e746d67c0",{"type":24,"title":362,"markdownContent":363,"audioMediaId":364},"What is Germ Theory? ","Germ theory is essentially the understanding that microscopic organisms cause disease. While it was first proposed in the 16th century, germ theory was developed and proved in the mid-1800s. Before that, from the time of Hippocrates in the 5th century BCE, Western medicine was centered around the *humoral theory* and each individual having a particular *humoral institution*. \n\n*Humoral* is derived from ‘humor,’ in this context meaning ‘fluid,’ and the human body was believed to consist of four humors: black bile, yellow bile, blood, and phlegm. Proper humoral balance translated to perfect health, whereas an imbalance of the humors resulted in disease.\n\n ![Graph](image://4eedab69-f249-4aed-90c8-84d1ee521db3 \"Humorism\")\n\nIn contrast to humoral theory, germ theory established that diseases were separate from the body, and it revolutionized the medical field and the understanding of disease. Its implications were so significant that it brought about an elevation in the social status of physicians and of medical research and practice.","7be04a67-4fb5-4bc3-af6d-d89aa55f4fbd",[366,373,380],{"id":367,"data":368,"type":51,"version":24,"maxContentLevel":34},"8232ba71-7592-4b05-8296-9074f1b0cd6e",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":369,"activeRecallAnswers":371},[370],"What is germ theory of disease?",[372],"The understanding that microscopic organisms cause disease.",{"id":374,"data":375,"type":51,"version":24,"maxContentLevel":34},"9b637665-7e16-4f11-8e60-45c15458bfd0",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":376,"activeRecallAnswers":378},[377],"What is humoral theory of disease?",[379],"Humoral is derived from ‘humor,’ in this context meaning ‘fluid,’ and the human body was believed to consist of four humors: black bile, yellow bile, blood, and phlegm. Proper humoral balance translated to perfect health, whereas an imbalance of the humors resulted in disease. ",{"id":381,"data":382,"type":51,"version":24,"maxContentLevel":34},"e83fb9a6-1c17-47ff-ab27-a450b738fd16",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":383,"binaryCorrect":385,"binaryIncorrect":387},[384],"What term was used by medieval people to describe the bodily fluids that they thought influenced mood?",[386],"Humors",[388],"Enzymes",{"id":390,"data":391,"type":24,"maxContentLevel":34,"version":24,"reviews":395},"907d55c5-5469-48ed-9887-bae9370e8d80",{"type":24,"title":392,"markdownContent":393,"audioMediaId":394},"Spontaneous Generation  ","One of the theories on disease origination that had dominated the medical field since the times of Ancient Greece was that of spontaneous generation, first suggested by Aristotle in 350 BCE. This theory proposed that living organisms could arise from non-living matter like soil and water, and that it was impossible to confirm whether microorganisms found in non-living matter were the cause or the product of decomposition. \n\nSome fascinating examples of *spontaneous generation* include that garbage in the streets created rats, scorpions could be manufactured using bricks and basil leaves, and crocodiles in Egypt were created by mud with the sun acting as catalyst. \n\n ![Graph](image://42dd2d1f-95a2-42c8-97bc-35f1443b4586 \"Birds generating from rotting wood\")\n\nIt wasn’t until the 1870s when Louis Pasteur proved that decomposition was indeed caused by microorganisms, that the concept of disease also being the result of microorganisms became a possibility. ","fe12e90c-07ee-49d5-87fe-00a52f54618b",[396,402,413],{"id":397,"data":398,"type":51,"version":24,"maxContentLevel":34},"4b4d37bb-7178-4c42-99e1-da5117b35b2a",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":399,"activeRecallAnswers":401},[400],"Who proved that decomposition was caused by microorganisms?",[196],{"id":403,"data":404,"type":51,"version":24,"maxContentLevel":34},"5da89f92-42f2-47f7-8ec0-d87a2b09436d",{"type":51,"reviewType":34,"spacingBehaviour":24,"multiChoiceQuestion":405,"multiChoiceCorrect":407,"multiChoiceIncorrect":409},[406],"Who was the first to suggest the spontaneous generation theory, which proposed that living organisms could arise from non-living matter like soil and water?",[408],"Aristotle",[410,411,412],"Hippocrates","Plato","Spontaneo",{"id":414,"data":415,"type":51,"version":24,"maxContentLevel":34},"6e9622ef-3c7f-402d-8ca6-52f856d0525c",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":416,"binaryCorrect":418,"binaryIncorrect":419},[417],"Proponents of spontaneous generation proposed that crocodiles in Egypt were created by mud with the sun acting as catalyst.",[318],[316],{"id":421,"data":422,"type":24,"maxContentLevel":34,"version":24,"reviews":426},"480a137b-813e-4238-8bca-eae91413e8ee",{"type":24,"title":423,"markdownContent":424,"audioMediaId":425},"Early Germ Theories ","The first to describe the concept that diseases could be spread by ‘seed-like entities’ was Girolamo Fracastoro, an Italian physician, in the 1500s, who proposed that disease could be spread in 3 ways: by direct contact; by carriers such as dirty clothes; and through the air.  Fracastoro was the first to scientifically explore and understand the nature of germs, infection, contagion, and disease transmission. \n\nIn the early 1800s, Agostino Bassi, an Italian bacteriologist, conducted a series of experiments investigating the silkworm disease which was plaguing Italy and France. Following 25 years of research, he was able to demonstrate that the disease was contagious and was caused by a microscopic, parasitic fungus, concluding that it was transmitted among the silkworms through contact and by infected food. Bassi proceeded to theorize that disease in humans and animals was also caused by microorganisms, though never proved it.","2bc9cd11-27da-44d0-b62e-4bbe55c9db0b",[427],{"id":428,"data":429,"type":51,"version":24,"maxContentLevel":34},"6673b1a5-4c67-4ff4-9c25-7a38c15d213c",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":430,"clozeWords":432},[431],"Agostino Bassi, an Italian scientist, spent 25 years researching silkworms.",[433],"silkworms.",{"id":435,"data":436,"type":25,"version":24,"maxContentLevel":34,"pages":438},"a25f2ada-f1ea-40b9-a176-d61c5b869114",{"type":25,"title":437},"Pioneers of Microbiology",[439,453,467],{"id":440,"data":441,"type":24,"maxContentLevel":34,"version":24,"reviews":445},"e19e2ea6-7cda-427b-93f6-dcd72aecd224",{"type":24,"title":442,"markdownContent":443,"audioMediaId":444},"Louis Pasteur ","Louis Pasteur was a French chemist and microbiologist, and the first to experimentally prove the connection between germs and disease in the 1860s. Using swan-necked flasks that he had created, he boiled broths and realized that the liquid remained free of microbes until he broke the neck of the flasks and air particles were allowed to drift in. \n\nOnce the air was allowed in, Pasteur noticed under a microscope that microorganisms were growing in the liquid. In other words, keeping sterilized water in a sealed flask prevented germs from entering it, whereas exposing it to air would encourage microorganisms to breed again.\n\nPasteur’s conclusive experiments served to debunk the theory of spontaneous generation – essentially that life arises from non-living matter – that had been dominating the medical field from ancient times. His pioneering studies revolutionized the understanding of diseases and their etiology and laid the foundation for modern day treatment.\n\n ![Graph](image://c8b8d9cb-b245-4c29-8b39-301517a688bd \"Louis Pasteur \")\n\n","09cc7d70-f67d-4144-ad88-2f685a65ee72",[446],{"id":447,"data":448,"type":51,"version":24,"maxContentLevel":34},"ca14a77b-12d2-4f4c-8aac-37b9ad57a15f",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":449,"activeRecallAnswers":451},[450],"How did Louis Pasteur prove that spontaneous generation did not exist?",[452],"By demonstrating that keeping water sterilised by boiling in a sealed flask prevented germs from entering it.",{"id":454,"data":455,"type":24,"maxContentLevel":34,"version":24,"reviews":459},"27948296-382b-4f14-9708-3f86c5e68b8d",{"type":24,"title":456,"markdownContent":457,"audioMediaId":458},"Robert Koch","While Louis Pasteur proved that germs were indeed linked to disease in the 1860s, German scientist Robert Koch – one of the founders of bacteriology – developed sophisticated laboratory techniques in the 1870s to prove that specific germs cause specific diseases. Koch observed bacterial growth on microscope slides, and his first important discovery was anthrax which was killing much livestock at the time. \n\nKoch determined the 4 criteria to determine whether a specific organism causes disease, known as ‘Koch’s postulates: ’firstly, a specific microorganism is always associated with a given disease. Secondly, the microorganism can be isolated from the diseased animal and grown in pure culture in the laboratory. Thirdly, the cultured microbe will cause disease when transferred to a healthy animal. And finally, the same type of microorganism can be isolated from the newly infected animal.\n\nAfter extensive experiments, Koch also discovered the bacteria that cause septicemia, tuberculosis, and cholera, and his methods enabled others to identify many more pathogens in the years following. In 1905, Koch received the Nobel Prize for Physiology or Medicine for his work on tuberculosis.\n\n ![Graph](image://377ac1f7-d0be-49a4-a43c-8af65b9b393c \"Robert Koch\")\n\n","8a2a2c8f-d34c-4e93-8963-8b705d832ebc",[460],{"id":461,"data":462,"type":51,"version":24,"maxContentLevel":34},"c8116156-ab6f-49c6-a932-941c858adae3",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":463,"activeRecallAnswers":465},[464],"Robert Koch is one of the founders of bacteriology - what are his largest contributions?",[466],"Developed sophisticated laboratory techniques in the 1870s to prove that specific germs cause specific diseases (eg. tuberculosis or cholera).",{"id":468,"data":469,"type":24,"maxContentLevel":34,"version":24,"reviews":473},"2e08a4a0-db1a-4e4b-9bd7-bfabdd8d5401",{"type":24,"title":470,"markdownContent":471,"audioMediaId":472},"Joseph Lister ","In the early 1860s the mortality rate of surgical patients due to post-operative infections was estimated to be close to 50%. This staggering statistic might make more sense if one considers that, in those days, doctors arrived in the operating theatre in their street clothes without even washing their hands. \n\nIn 1864, Joseph Lister, a British surgeon, came across Louis Pasteur’s work on germ theory and sensed that germs could explain wound sepsis. As a result, Lister began spraying carbolic acid on open fracture wounds, which were almost always treated with amputation. \n\nIn 1865, Lister was successful at healing wounds without infections. From then on, he created a strict protocol for sterilizing everything before and after surgery, which serves as an inspiration to surgeons today. His discovery revolutionized surgery and drastically reduced post-operative deaths due to infections. Lister was a pioneer in preventative medicine and his name is associated with antisepsis – there is even a mouthwash named after him.\n\n ![Graph](image://1c75b1df-6500-4ba3-abe1-a462983f6683 \"Joseph Lister\")","bcc6972e-2f7c-45ff-b68c-fc395cad6edf",[474,481],{"id":475,"data":476,"type":51,"version":24,"maxContentLevel":34},"c9a9ef44-991e-43c4-9e65-cd97d5f83809",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":477,"activeRecallAnswers":479},[478],"Who is Listerine named after?",[480],"Joseph Lister, a British surgeon.",{"id":482,"data":483,"type":51,"version":24,"maxContentLevel":34},"d9530ef7-1412-4660-8351-75196c2fffea",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":484,"activeRecallAnswers":486},[485],"What did Joseph Lister contribute to surgery?",[487],"He helped reduce post-operative deaths due to infections by sterilising the medical theatre.",{"id":489,"data":490,"type":25,"version":24,"maxContentLevel":34,"pages":492},"c6007c91-d630-4a4a-b097-c1d3e31b56f5",{"type":25,"title":491},"Public Health and Hygiene",[493],{"id":494,"data":495,"type":24,"maxContentLevel":34,"version":24,"reviews":499},"6f035e15-21ea-4af5-a897-c2ff8a747732",{"type":24,"title":496,"markdownContent":497,"audioMediaId":498},"Public Awareness and Prevention vs Treatment","The development of germ theory and the discoveries of Pasteur, Koch, and Lister required a new public awareness of how germs cause diseases and of how germs spread from one person to another. In the late 1800s, new guidelines were issued regarding personal and home hygiene, cooking, heating, and plumbing, some which we still use today, and which were greatly emphasized with the outbreak of COVID-19. \n\nGerm theory revolutionized the understanding of disease and provided the necessary knowledge to limit contagion and prevent disease outbreaks. It is essential to note, however, that while germ theory provided answers regarding the cause of disease, it did not necessarily provide answers toward the treatment of those diseases. In other words, the identification of a disease cause does not automatically lead to a cure for that disease.","d1f631ea-b30f-4d46-aa0f-86e830708a03",[500],{"id":501,"data":502,"type":51,"version":24,"maxContentLevel":34},"2b0b2469-737e-4adb-bdab-c68d1ab7defc",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":503,"clozeWords":505},[504],"While germ theory provided answers regarding the cause of disease, it did not necessarily provide answers toward the treatment of those diseases.",[506,507],"cause","treatment",{"id":509,"data":510,"type":27,"maxContentLevel":34,"version":24,"orbs":513},"b75865e0-70f9-4870-8590-fb149dfa963a",{"type":27,"title":511,"tagline":512},"Anesthesia","Its hard to imagine medical procedures without anesthetic for pain relief. But Anesthesia is a realtively recent development. learn about their history, and (what was used before!)",[514,621,686],{"id":515,"data":516,"type":25,"version":24,"maxContentLevel":34,"pages":518},"9304a5e2-3414-41d2-b944-4dc2b725adeb",{"type":25,"title":517},"The Evolution of Pain Management",[519,535,565,601,615],{"id":520,"data":521,"type":24,"maxContentLevel":34,"version":24,"reviews":525},"f4b3ee62-6cdd-4cdd-a7d7-8369ef3d9f47",{"type":24,"title":522,"markdownContent":523,"audioMediaId":524},"Introduction","Throughout the centuries, there have been many attempts to relieve pain during medical procedures, from blows to the head to induce unconsciousness, to ingestion of herbal mixtures, and even hypnotism. Nowadays, we rely on anesthesia - a medical treatment that prevents patients from feeling pain during procedures such as surgery. \n\nUp until the mid-1800s, doctors could only offer patients opium, alcohol, and a bullet or rope to bite on to deal with the excruciating pain of surgery, which was only performed as a last resort. One of the very few accounts describing the pain of surgery is that of Fanny Burney, an English novelist who had to undergo a mastectomy in 1811, and recounted her experience as “terror that surpasses all description.” \n\n ![Graph](image://305765d5-efd0-49e2-a396-39fb049e11f1 \"A particularly painful tooth extraction\")\n\n","7154c5a4-aacc-4e6a-85b7-7306b9bfef16",[526],{"id":527,"data":528,"type":51,"version":24,"maxContentLevel":34},"f154446e-affb-4992-8b5e-42b308c28d1c",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":529,"clozeWords":531},[530],"Methods used to relieve pain during medical procedures prior to inventing anesthesia included blows to the head, herbal mixtures and even hypnotism.",[532,533,534],"blows to the head","herbal","hypnotism",{"id":536,"data":537,"type":24,"maxContentLevel":34,"version":24,"reviews":541},"0a554b36-b3ba-4255-bf66-fbe4bf31dd1a",{"type":24,"title":538,"markdownContent":539,"audioMediaId":540},"The Discovery of Gases","During the Enlightenment in the mid-1700s, gases like carbon dioxide and nitrous oxide were discovered, which were also explored for their therapeutic and anesthetic properties. In 1779, Sir Humphry Davy, a British chemist who discovered several chemical elements and compounds, suggested the use of nitrous oxide – known today as laughing gas – to produce pain relief, which he first tested on himself. \n\nIn the early 1820s, British doctor and surgeon Henry Hickman, in his efforts to alleviate pain during surgery for his patients, experimented on animals using carbon dioxide gas while operating on them. The animals seemingly felt no pain and recovered fully from what he called a state of ‘suspended animation.’ Hickman though was unsuccessful in publishing his research and died shortly after.\n\nIn 1844, an American dentist called Horace Wells was the first to use nitrous oxide for a tooth extraction of one of his patients, but it didn’t work as adequate pain relief. Wells took this failure to heart and didn’t experiment further.\n","c9fb4e93-9d72-43cf-be5a-278bff6c69c2",[542,549,558],{"id":543,"data":544,"type":51,"version":24,"maxContentLevel":34},"0411083c-8b30-422a-8859-1113f53765df",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":545,"activeRecallAnswers":547},[546],"Why didn't the dentist Horace Wells continue using nitrous oxide as pain relief in tooth extraction?",[548],"Because it did not provide a sufficient level of pain relief",{"id":550,"data":551,"type":51,"version":24,"maxContentLevel":34},"55564dea-a64d-4672-8430-85c409d2fecd",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":552,"binaryCorrect":554,"binaryIncorrect":556},[553],"What gas did British doctor Henry Hickman use to induce a state of ‘suspended animation' in animals which he operated?",[555],"carbon dioxide",[557],"carbon monoxide",{"id":559,"data":560,"type":51,"version":24,"maxContentLevel":34},"6d069a0d-f138-4e85-a71d-b4dbff056bc2",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":561,"activeRecallAnswers":563},[562],"What is another name for nitrous oxide, a chemical gas with anesthetic properties discovered by an 18th century British chemist Sir Humphry Davy?",[564],"laughing gas",{"id":566,"data":567,"type":24,"maxContentLevel":34,"version":24,"reviews":571},"384f0049-e421-4710-a012-2a7557805745",{"type":24,"title":568,"markdownContent":569,"audioMediaId":570},"The Discovery of General Anesthesia ","In the late 18th and early 19th centuries, chemists and doctors experimented with various gases to provide pain relief during surgeries, but their efforts weren’t successful enough to be established. However, in the mid-1840s, a young American dentist named William Morton was committed to discovering an effective pain relief and settled on *sulfuric ether*. Morton experimented on small animals and discovered that, when they inhaled ether, they passed out and became unresponsive. \n\nOn October 16th, 1846, Morton performed the first general anesthesia on a patient in a public demonstration at Massachusetts General Hospital. A surgeon then performed a tumor excision on the patient’s neck without any distress. Much to everyone’s surprise, ether had successfully worked as an anesthetic, hailing a new era in the field of medical surgery. The operating theater where the above occurred is known as the Ether Dome and is still preserved at the Massachusetts General Hospital, and the 16th of October is celebrated as World Anesthesia Day.\n\n ![Graph](image://56e29c4c-dc1a-4972-ab80-15c7f479ce2a \"Anesthesia 1914\")\n\n","ad693204-7dae-498a-9272-504ab1025b9c",[572,583,594],{"id":573,"data":574,"type":51,"version":24,"maxContentLevel":34},"0286cf6c-6347-47c6-a8a9-dc8480b995b6",{"type":51,"reviewType":34,"spacingBehaviour":24,"multiChoiceQuestion":575,"multiChoiceCorrect":577,"multiChoiceIncorrect":579},[576],"When was the first instance of successful general anesthesia conducted?",[578],"1846",[580,581,582],"1746","1946","1914",{"id":584,"data":585,"type":51,"version":24,"maxContentLevel":34},"2c251ea0-df4b-4349-ba1b-a236417ed6b2",{"type":51,"reviewType":34,"spacingBehaviour":24,"multiChoiceQuestion":586,"multiChoiceCorrect":588,"multiChoiceIncorrect":590},[587],"When is World Anesthesia Day celebrated?",[589],"16th October",[591,592,593],"29th March","31st February","12th November",{"id":595,"data":596,"type":51,"version":24,"maxContentLevel":34},"f7ff21f8-a1f2-44f6-b5e7-0493e8db7c03",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":597,"activeRecallAnswers":599},[598],"Which gas was used by William Morton, the surgeon who conducted the first successful general anesthesia in Massachusetts General Hospital?",[600],"Sulfuric ether",{"id":602,"data":603,"type":24,"maxContentLevel":34,"version":24,"reviews":607},"e57bbba1-52a1-45c3-905b-bddca63585c7",{"type":24,"title":604,"markdownContent":605,"audioMediaId":606},"Chloroform","The successful use of ether as a general anesthetic in the U.S. led to the discovery of chloroform's use as an anaesthetic in England in 1847, by James Simpson, who was a Professor of Midwifery and had pioneered inhalational analgesia for women in labor. English doctor John Snow popularized the use of chloroform by using it on Queen Victoria for the birth of her 8th child in 1853. Eventually, chloroform became the most commonly used anesthetic in England, and, by the end of the 19th century, anesthesia had become commonplace in surgical procedures.  \n\nChloroform, however, was a very toxic compound and was also unpredictable, which made maintenance of anesthesia very difficult. It was eventually associated with a substantially high death rate due to cardiac arrest, the first one occurring in 1848 and witnessed by Simpson himself. In other cases, it caused delayed poisoning due to liver damage, and, by the beginning of the 20th century, the need for other, better substances was becoming evident.  ","0f5d2ee9-0cbf-4148-9c09-3899ddf5a2da",[608],{"id":609,"data":610,"type":51,"version":24,"maxContentLevel":34},"650574a9-6d84-4291-9dc1-880a02b5fa45",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":611,"activeRecallAnswers":613},[612],"What was the massive innovation to 19th century anesthesia practice proposed by Joseph Clover?",[614],"To mix several gases instead of using just one",{"id":616,"data":617,"type":24,"maxContentLevel":34,"version":24},"ff79ac94-c9ae-4f28-acb8-cd1b0fa4825f",{"type":24,"title":618,"markdownContent":619,"audioMediaId":620},"Drug Combination","During the 1860s, the use of nitrous oxide made a return with doctors experimenting with it on both sides of the Atlantic as it was more pleasant to inhale than ether, and less risky than chloroform. However, nitrous oxide on its own was safe only for brief procedures and was mostly used for tooth extractions. \n\nJoseph Clover, an English surgeon who became one of England’s leading anesthesiologists, was the first to consider combining nitrous oxide with another gas, thus starting the trend of using a combination of several drugs, rather than a larger, more toxic, dose of one. Clover realized that mixing nitrous oxide with ether would induce anesthesia much faster and also safely make it last longer for more complex surgical procedures.\n\n![Graph](image://e864a906-91ea-497a-9f27-7c0d08cd5785 \"Joseph Thomas Clover\")\n\n","49f92a50-b9c4-41c6-a919-242b9a94a105",{"id":622,"data":623,"type":25,"version":24,"maxContentLevel":34,"pages":625},"3ffcc6b7-2693-42cf-a5d3-653a9ee35043",{"type":25,"title":624},"Advancements in Anesthetic Techniques",[626,649,672],{"id":627,"data":628,"type":24,"maxContentLevel":34,"version":24,"reviews":632},"35de8c12-bd5e-4043-a86d-53238cc8989d",{"type":24,"title":629,"markdownContent":630,"audioMediaId":631},"Local Anesthesia","James Simpson, the English Professor of Midwifery who discovered chloroform in 1847, also suggested that ‘local’ anesthesia would be equally useful as general anesthesia. He suggested ‘cooling’ as a method, which led another doctor named Benjamin Richardson to develop the ether spray. Rapid evaporation of ether produced the cooling effect, hence the term ‘freezing’, which is still being used today. \n\nIn 1884, Austrian ophthalmologist Carl Koller was experimenting with different substances to find one that would be safe and effective as a local anesthetic for use during eye surgery. In pharmaceutical circles, the numbing effect of cocaine had already been recognized, and so Koller decided to try placing a few drops of cocaine solution to the cornea. His experiment proved a huge success as cocaine produced insensibility and complete numbing of the eye. \n\nNews of this success traveled quickly and so cocaine became a favorite among doctors as a local anesthetic. This led to the development of the peripheral nerve block, spinal anesthesia in 1898, and epidural block in 1921.","0656e5d1-f9fc-45a5-aaf4-e0d4644275bc",[633,640],{"id":634,"data":635,"type":51,"version":24,"maxContentLevel":34},"36159959-4fd1-4708-8fcd-2635770547b9",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":636,"activeRecallAnswers":638},[637],"What was the first local anesthetic to be made?",[639],"Ether spray was developed, which produced a cooling effect",{"id":641,"data":642,"type":51,"version":24,"maxContentLevel":34},"98194aed-e504-4d31-b0b2-cad32b39d653",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":643,"binaryCorrect":645,"binaryIncorrect":647},[644],"What substance was first used as a local anesthetic deemed safe for eye surgery?",[646],"Cocaine",[648],"Codamine",{"id":650,"data":651,"type":24,"maxContentLevel":34,"version":24,"reviews":655},"2e530d47-5d71-4482-ba91-b76a5b033153",{"type":24,"title":652,"markdownContent":653,"audioMediaId":654},"Anesthesia Developments in the 20th Century","The late 1930s saw the introduction of pentothal or sodium thiopentone, a barbiturate, making general anesthesia much more pleasant for patients compared to nitrous oxide and ether. In 1942, doctors in Montreal introduced ‘curare’ as a muscle relaxant. ‘Curare’, which had first been observed in South American arrows, allowed a lighter depth of general anesthesia than previously possible. This was essential for thorax and abdomen surgery and required anesthetists to learn how to insert a tube through the trachea to allow mechanical ventilation of the lung and ‘control’ breathing. \n\nHalogenated hydrocarbons, which were highly potent, non-flammable anesthetic agents, were introduced in the 1950s replacing ether and chloroform in most operating theatres.\n\nIn the 1960s, new drugs and new monitoring equipment were developed, allowing surgery to be extended to increasingly complex procedures, and today inhaled anesthetics are combined with intravenous anesthetics for ultimate patient comfort and overall surgical success. ","3c0edbbe-486a-495c-a32b-d4d7ff89520d",[656,664],{"id":657,"data":658,"type":51,"version":24,"maxContentLevel":34},"21409ff3-6e4d-44e3-bdae-ba702449afc8",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":659,"activeRecallAnswers":661},[660],"What is 'curare' and where was it first observed?",[662,663],"It is a muscle relaxant","In South American arrows",{"id":665,"data":666,"type":51,"version":24,"maxContentLevel":34},"2b83a2c9-967d-41af-9b89-52563fce35f0",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":667,"clozeWords":669},[668],"The late 1930s saw the introduction of pentothal or sodium thiopentone, a barbiturate, making general anesthesia much more pleasant for patients compared to nitrous oxide and ether.",[670,671],"pentothal","much more pleasant",{"id":673,"data":674,"type":24,"maxContentLevel":34,"version":24,"reviews":678},"0c1fbda9-f643-4acf-bc27-39d0d87bfd6f",{"type":24,"title":675,"markdownContent":676,"audioMediaId":677},"Evolution of Anesthesia Devices ","The first anesthesia device was the ether inhaler used in 1846 by American dentist William Morton in the first ever general anesthesia to be performed. This was then further developed in 1877 by Joseph Clover who invented an inhaler that combined nitrous oxide with ether and dispersed the mix to the patient with a face mask. \n\nDuring the 1940s, another piece of equipment was being perfected – the hollow needle, which allowed easier administration of opium as pain management. Intravenous anesthetics were widely used during WWII as inhaled versions were too instable to use in the battlefield. \n\nIn 1917, Henry Edmund Gaskin Boyle invented the first continuous flow anesthetic machine, known as the ‘Boyle Apparatus.’ The Boyle Apparatus ensured patients safely received oxygen while enabling ventilation, accurately mixing oxygen with a stable level of anesthetic gas. \n\nThe Boyle Apparatus was the dominant anesthetic machine for much of the 20th century, and today contemporary anesthesia devices retain many of the key characteristics found in the original.\n\n![Graph](image://b55ca881-111e-458e-9f92-eb5f175dea8c \"A Diagram of filtration in the Boyle Apparatus\")\n\n","687165d0-7f12-453a-9a54-f2c80a8fe3aa",[679],{"id":680,"data":681,"type":51,"version":24,"maxContentLevel":34},"c65ba037-26a7-4ff9-a6d4-c1fe5eeea59d",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":682,"clozeWords":684},[683],"Contemporary anesthesia devices retain many of the key characteristics found in the original Boyle Apparatus.",[685],"Boyle Apparatus",{"id":687,"data":688,"type":25,"version":24,"maxContentLevel":34,"pages":690},"b72b53e7-79bf-481a-8cb6-98875937900b",{"type":25,"title":689},"The Future of Anesthesia",[691],{"id":692,"data":693,"type":24,"maxContentLevel":34,"version":24,"reviews":697},"4923408c-54fb-4700-bbf6-e5644f0aeb19",{"type":24,"title":694,"markdownContent":695,"audioMediaId":696},"The Future of Anesthesia ","Today, ongoing research into how a person’s genetic makeup affects their response to certain anesthetics will hopefully allow for a more tailor-made, personalized approach for patients with safer and more effective results during and after anesthesia.  \n\nFurthermore, scientists are hoping that, with new advancements in research, understanding how anesthesia affects pain and consciousness could lead to new treatments for conditions such as epilepsy and even coma, and also help in further understanding consciousness itself. \n\nFinally, recent technological advancements are enabling further research into the field of anesthesia and are also changing the practice of anesthesiology. The integration of new technologies has improved the process of anesthesia delivery and overall patient care, while the experimental application of artificial intelligence has been showing potential to further transform the field.","60a86673-4ef1-4e47-969e-50a45a3dde78",[698],{"id":699,"data":700,"type":51,"version":24,"maxContentLevel":34},"0a451a4c-4d61-420e-8306-7f04e917b0f1",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":701,"clozeWords":703},[702],"Understanding how anesthesia affects pain and consciousness could lead to new treatments for conditions such as epilepsy and even coma, and also help in further understanding consciousness itself.",[704,705],"epilepsy","coma",{"id":707,"data":708,"type":27,"maxContentLevel":34,"version":24,"orbs":711},"4ea13a65-92f9-4604-a729-54c4492f2c19",{"type":27,"title":709,"tagline":710},"Diagnostic Medical Imaging","Learn all about the developments of medical imaging and radiology, which thankfully allow us to view inside the living human body without having to cut it open.",[712,790,870],{"id":713,"data":714,"type":25,"version":24,"maxContentLevel":34,"pages":716},"9e5a204a-51fb-4023-86a1-fd8be449afab",{"type":25,"title":715},"Introduction to Medical Imaging",[717,737,762],{"id":718,"data":719,"type":24,"maxContentLevel":34,"version":24,"reviews":722},"4dacba99-d858-421e-a991-65de69e6fe89",{"type":24,"title":522,"markdownContent":720,"audioMediaId":721},"Medical imaging, also referred to as radiology, consists of different types of technology that are used to view inside the living human body without having to cut it open. Each technology provides different information which can assist with the diagnosis and treatment of a specific disease or injury. Medical imaging offers invaluable anatomical and functional information and has contributed significantly to the advancement of modern medicine, changing the landscape of illness prevention and treatment, and saving countless lives each year. \n\nIn recognition of the impact and remarkable contribution that medical imaging has had on healthcare, International Day of Radiology is celebrated on 8th November each year, which is the anniversary of X-ray discovery by German physicist Wilhelm Roentgen.","46312d24-f5a1-46c2-b787-a7e51218c860",[723,730],{"id":724,"data":725,"type":51,"version":24,"maxContentLevel":34},"44da1955-1e35-4d54-adaa-296eab713a60",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":726,"activeRecallAnswers":728},[727],"When do we celebrate International Day of Radiology?",[729],"On November 8, the anniversary of X-ray discovery by German physicist Wilhelm Roentgen.",{"id":731,"data":732,"type":51,"version":24,"maxContentLevel":34},"959e0025-e94f-44be-892b-8b3a5a200781",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":733,"activeRecallAnswers":735},[734],"What is radiology?",[736],"Different types of technology that are used to view inside the living human body without having to cut it open.",{"id":738,"data":739,"type":24,"maxContentLevel":34,"version":24,"reviews":743},"c1dfecde-7c53-41aa-a8c3-655c4ad5272b",{"type":24,"title":740,"markdownContent":741,"audioMediaId":742},"The Discovery of the X-Ray","On November 8th, 1895, German physicist Wilhelm Roentgen was the first to observe X-rays. X-rays are a type of radiation called electromagnetic waves that act similar to light rays but at much shorter wavelengths. Roentgen noticed a glow coming from a chemically coated screen while he was testing cathode rays and their ability to pass through glass. The glow was caused by invisible rays originating from the glass tube he was using by penetrating the opaque black paper he had wrapped around the tube. \n\nFascinated, Roentgen experimented further, discovering that this new type of ray was capable of passing through the skin and other soft tissues of the body while leaving bones and metals visible. One of his first experiments shows a film of his wife Bertha's hand with her wedding ring clearly visible. The only reason he called these rays “X-rays” was because of their unknown nature. \n\nRoentgen’s discovery had made the invisible visible and was hailed a miracle by the medical community around the world. In 1901, he was awarded the Nobel Prize in Physics.\n\n ![Graph](image://46e7bc4b-19da-4f0c-87e1-be7f5e4126a1 \"Wilhelm Roentgen\")\n\n","ec498da4-8c03-4be2-9b9d-42755bff34fa",[744,751],{"id":745,"data":746,"type":51,"version":24,"maxContentLevel":34},"20d6f124-ad43-47e6-84dd-e8bf92054f85",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":747,"activeRecallAnswers":749},[748],"Who discovered X-rays?",[750],"German physicist Wilhelm Roentgen",{"id":752,"data":753,"type":51,"version":24,"maxContentLevel":34},"d00be785-6434-43f7-ace4-71cfd943533b",{"type":51,"reviewType":34,"spacingBehaviour":24,"multiChoiceQuestion":754,"multiChoiceCorrect":756,"multiChoiceIncorrect":758},[755],"When was the X-ray first observed?",[757],"November 8th, 1895",[759,760,761],"October 18th, 1895","November 12th 2003","October 9th 1885",{"id":763,"data":764,"type":24,"maxContentLevel":34,"version":24,"reviews":768},"d7203629-f816-410e-9025-47f1739466df",{"type":24,"title":765,"markdownContent":766,"audioMediaId":767},"Computed Tomography ","Computed tomography (CT) is a computerized X-ray imaging technique. During a CT scan, a narrow beam of X-rays is aimed at a patient while quickly rotating around the body, and the signals produced are then processed by the machine’s computer to generate cross-sectional images of the body, also known as ‘slices.’ These slices offer a lot more detailed information than conventional X-rays, showing soft tissue contrasted with anatomic details, thus allowing unprecedented diagnostic accuracy. \n\nThe first CT machine, considered one of the most important innovations of all time, was invented in 1967 by Sir Godfrey Hounsfield, a British engineer. American physicist Alan M. Cormack developed the early mathematical models used in CT. In 1979, both were awarded the Nobel Prize for Physiology or Medicine. \n\n ![Graph](image://083c7b30-4901-430a-88ce-09d0deed0d54 \"A Modern CT machine\")\n\n","bba8a384-49a6-4f85-a26e-e89d3f069235",[769,776,783],{"id":770,"data":771,"type":51,"version":24,"maxContentLevel":34},"278274ba-2785-421a-84d8-f4291b3ada6e",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":772,"activeRecallAnswers":774},[773],"What did Sir Godfrey Hounsfield, a British engineer, invent?",[775],"The first computed tomography machine.",{"id":777,"data":778,"type":51,"version":24,"maxContentLevel":34},"311d9b1d-b5f1-4f6c-b337-e924d4119c02",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":779,"activeRecallAnswers":781},[780],"What can you see on computed tomography scan and not a typical X-ray one?",[782],"A lot more details particularly about the soft tissue.",{"id":784,"data":785,"type":51,"version":24,"maxContentLevel":34},"99a92a90-8851-4723-bdc5-f656ff705d29",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":786,"activeRecallAnswers":788},[787],"What is Computed tomography (CT)?",[789],"A type of X-ray analysis using a narrow beam of X-rays and a computer which produces cross-sectional images of the body (called slices). ",{"id":791,"data":792,"type":25,"version":24,"maxContentLevel":34,"pages":794},"1dbc957d-5607-4aa8-8feb-63ff36ba2394",{"type":25,"title":793},"Advanced Imaging Techniques",[795,818,849],{"id":796,"data":797,"type":24,"maxContentLevel":34,"version":24,"reviews":801},"a4c0ff24-e141-45c5-bd65-6eaade7f4f3b",{"type":24,"title":798,"markdownContent":799,"audioMediaId":800},"Magnetic Resonance Imaging ","Magnetic resonance imaging (MRI) is very different to CT as it uses different physical principles and doesn’t involve X-rays. It is based on a phenomenon called ‘nuclear magnetic resonance’ (NMR) and was discovered in the 1930s simultaneously and independently by two American scientists – Felix Bloch at Stanford University and Edward Purcell at Harvard –  and involves magnetic fields and radio waves that cause atoms to give off tiny signals. \n\nThe first MR scanner was completed in 1977 by Raymond Damadian, an American physician who wanted to invent a machine that would show human tissue and diagnose disease. And he did just that. In MRI technology, a powerful magnet produces a fixed magnetic field around the patient while radiofrequency pulses excite protons within the body. An image is created by capturing the return signals from the excited protons as they relax back to a resting state. \n\nMRI is considered the ultimate medical imaging technique because of the soft tissue contrast and anatomical details it provides, and today it is used in almost every medical subspecialty. ","6af4df6c-f66b-4899-80b1-11f4e6f29366",[802,809],{"id":803,"data":804,"type":51,"version":24,"maxContentLevel":34},"ce23f4d5-6e9a-4526-b87a-e1b5fa101665",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":805,"activeRecallAnswers":807},[806],"MRI scans are a type of medical imaging machine. What do the letters in MRI stand for?",[808],"Magnetic resonance imaging",{"id":810,"data":811,"type":51,"version":24,"maxContentLevel":34},"fefcb0f0-9329-45d2-a62c-75c9e4da6163",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":812,"clozeWords":814},[813],"In MRI technology, a powerful magnet produces a fixed magnetic field while radiofrequency pulses excite protons within the body. An image is created by capturing the return signals from as they return to rest. ",[815,816,817],"magnet","radiofrequency","protons",{"id":819,"data":820,"type":24,"maxContentLevel":34,"version":24,"reviews":824},"7a2305ca-0b9e-4735-8145-983d7d526726",{"type":24,"title":821,"markdownContent":822,"audioMediaId":823},"Ultrasound","Ultrasound uses high-frequency soundwaves that are above the range of human hearing and are transmitted into the body. The echoes produced and reflected are plotted into an image. \n\nThe beginning of ultrasound technology can be traced back to 1790 when Italian biologist Lazzaro Spallanzani discovered the echolocation used by bats to maneuver through the air; they use their hearing to capture the return of the high-frequency sound they emit, in order to navigate in the dark. \n\nThe first use of ultrasound as a medical diagnostic imaging technique was in 1942, when neurologist Karl Dussik attempted to locate brain tumors through the human skull. In 1958, gynecologist Ian Donald was the first to use ultrasound to study the unborn fetus, uterus, and the pelvis in pregnant women. Since then, ultrasound technology has continued to advance, making it an inexpensive and widely available imaging modality.","b9ea7446-856e-4c3d-a729-4476e7a40b7d",[825,833,841],{"id":826,"data":827,"type":51,"version":24,"maxContentLevel":34},"02d79acb-f328-4702-8a01-d38c9a61f508",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":828,"clozeWords":830},[829],"In 1958, gynecologist Ian Donald was the first to use ultrasound to study the unborn fetus.",[831,832],"ultrasound","unborn fetus",{"id":834,"data":835,"type":51,"version":24,"maxContentLevel":34},"09a25410-5c30-47a4-95c0-05216a7d5fff",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":836,"clozeWords":838},[837],"The first use of ultrasound as a medical diagnostic imaging technique was in 1942, when neurologist Karl Dussik attempted to locate brain tumors.",[839,840],"1942","brain tumors",{"id":842,"data":843,"type":51,"version":24,"maxContentLevel":34},"51aee11b-ea87-4a81-af96-fff0b27c2314",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":844,"clozeWords":846},[845],"Ultrasound uses high-frequency soundwaves that are above the range of human hearing and are transmitted into the body. The echoes produced and reflected are plotted into an image. ",[847,848],"high-frequency soundwaves","echoes",{"id":850,"data":851,"type":24,"maxContentLevel":34,"version":24,"reviews":855},"f76a609f-5064-4c56-a83c-ee0adccaf260",{"type":24,"title":852,"markdownContent":853,"audioMediaId":854},"Positron Emission Tomography ","Positron emission tomography (PET) is a result of advances across several scientific fields such as physics, mathematic, chemistry, computer science and biology. Dr Michel Ter-Pogossian, a nuclear scientist at Washington University, is considered the father of PET as his experiments in the 1950s led to the development of PET as a medical diagnostic tool. \n\nAccording to Johns Hopkins Medicine, PET is “a type of nuclear medicine procedure that measures metabolic activity of the cells of body tissues. PET is actually a combination of nuclear medicine and biochemical analysis.”\n\nIn PET scans, patients are injected with a radioactive drug called tracer which will then collect in areas of the body with higher level of metabolic or biochemical activity, thus indicating disease. The huge advantage of this type of imaging is that the tracer can detect diseases before they show up in CT or MRI, and today it can be used in combination with those to provide exceedingly accurate disease detection and diagnosis. \n\n ![Graph](image://58eb5cbc-90c8-4e18-8d02-bdd47d0ca93c \"A PET Scan\")\n\n","46a27f73-c09a-496f-9250-35f98d225e8a",[856,863],{"id":857,"data":858,"type":51,"version":24,"maxContentLevel":34},"4b2432db-6e3d-4a19-a0b7-998d850be2e2",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":859,"activeRecallAnswers":861},[860],"How does a PET scan work?",[862],"In PET scans, patients are injected with a radioactive drug called tracer which will then collect in areas of the body with higher level of metabolic or biochemical activity, thus indicating disease. ",{"id":864,"data":865,"type":51,"version":24,"maxContentLevel":34},"ca23fb9d-2a89-4c5b-9b16-5f6bd61e0b2d",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":866,"activeRecallAnswers":868},[867],"What do the letters in PET stand for in the context of medical imaging?",[869],"Positron emission tomography",{"id":871,"data":872,"type":25,"version":24,"maxContentLevel":34,"pages":874},"ab5dc0b3-260c-4e2e-802b-701782d150d4",{"type":25,"title":873},"Challenges and Considerations in Medical Imaging",[875],{"id":876,"data":877,"type":24,"maxContentLevel":34,"version":24,"reviews":881},"c5b6d263-f5be-4553-bac5-a8870737b775",{"type":24,"title":878,"markdownContent":879,"audioMediaId":880},"Challenges in Medical Imaging","Medical imaging has grown faster than any other medical service. As a result, doctors are increasingly relying on imaging and laboratory testing, thus increasing healthcare costs. \n\nHowever, as much as medical imaging plays a part in diagnosis, it is also a potential source of diagnostic errors. The interpretation of diagnostic medical imaging is difficult to mechanize or automate; it is very dependent on radiologists’ knowledge and perception. In fact, most missed radiological diagnoses are attributable to interpretation errors of radiologists. \n\nAnother challenge is the increased exposure of patients to ionizing radiation and nuclear medicine, which, in turn, increases malignancy risks. According to the National Research Council of the National Academies, while high doses of ionizing radiation can produce damaging effects within days after exposure, low levels used in diagnostic imaging can produce ‘late’ effects, like cancer, many years after initial exposure.","1174eb7a-11e9-4ab5-baf3-6a573a86b9c9",[882],{"id":883,"data":884,"type":51,"version":24,"maxContentLevel":34},"bf930a6d-bd3a-4b07-8dd4-b5b6beab897b",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":885,"clozeWords":887},[886],"Medical imaging has grown faster than any other medical service.",[888],"faster than",{"id":890,"data":891,"type":27,"maxContentLevel":34,"version":24,"orbs":894},"f939d5a3-3eda-457e-8a63-20d8ef95a896",{"type":27,"title":892,"tagline":893},"Plastic Surgery","Plastic surgey today is synonymous with the quest for youth, however it actually dates back to antiquity and may be one of the world's oldest healing treatments. Learn about its history from antiquity to WW2 to the modern day.",[895,978,1033],{"id":896,"data":897,"type":25,"version":24,"maxContentLevel":34,"pages":899},"9365eb9f-d3a5-4208-980d-0de2d121f98a",{"type":25,"title":898},"The Origins and Early Development of Plastic Surgery",[900,929,957],{"id":901,"data":902,"type":24,"maxContentLevel":34,"version":24,"reviews":905},"c3feef04-31ed-4a85-ac00-fedb1092585c",{"type":24,"title":522,"markdownContent":903,"audioMediaId":904},"Each year, the lives of millions of people around the world who suffer from congenital malformations, disfiguring injuries, severe burns, and more, are improved by plastic and reconstructive surgeons.\n\nThese days, plastic surgery has become synonymous with the eternal quest for youth and beauty, and the development of the field is popularly believed to have taken place over the last 30 years or so. It may come as a surprise then that plastic surgery actually dates back to antiquity and may well be one of the world’s oldest healing treatments, driven by medical necessity. The oldest known medical text referring to surgical procedures to correct injuries is the *Edwin Smith Papyrus*, named after the American Egyptologist that discovered it in the late 19th century, and is considered to be around 4500 to 5000 years old. \n\nPlastic surgery is a bit of misnomer and the term in English is misleading –  *plastic* is actually derived from the Greek word ‘plastikos’, which means “capable of being shaped or molded.”","d9e0e412-f85b-42fb-bbc7-35317445813b",[906,915,922],{"id":907,"data":908,"type":51,"version":24,"maxContentLevel":34},"12a1a0e9-a8a7-4cf1-bfa2-b9731c86a91d",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":909,"binaryCorrect":911,"binaryIncorrect":913},[910],"From when does the oldest known medical text referring to plastic injury date?",[912],"Before 1600 BCE",[914],"After 1600 CE",{"id":916,"data":917,"type":51,"version":24,"maxContentLevel":34},"d3776353-6f30-4e35-ab88-64291df9d580",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":918,"activeRecallAnswers":920},[919],"What is the Edwin Smith Papyrus?",[921],"Dating back to 1600 BC Egypt, it's one of the oldest medical texts in the world, containing the first mention of plastic surgery.",{"id":923,"data":924,"type":51,"version":24,"maxContentLevel":34},"d97bbab9-95f6-4b61-84b4-c8c49eb2edd5",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":925,"activeRecallAnswers":927},[926],"Where does the 'plastic' in 'plastic surgery' come from?",[928],"From the Greek word ‘plastikos’, which means “capable of being shaped or molded.",{"id":930,"data":931,"type":24,"maxContentLevel":34,"version":24,"reviews":935},"7207997b-0e82-4f7d-a56d-74388c532e07",{"type":24,"title":932,"markdownContent":933,"audioMediaId":934},"Plastic Surgery in Ancient Times ","Around 800 BCE, an Indian physician named Sushruta was carrying out procedures very similar to modern-day rhinoplasty. In those times, people who committed adultery would get their noses cut off as a public sign of shame. Sushruta would graft skin from the forehead to the nose, with plant pieces holding the shape inside the nostrils.\n \nHis advanced technique for skin grafts was recorded in detail in a text called *Sushruta Samhita*, the first of its kind in ancient history, establishing Sushruta as the father of plastic surgery. The text was translated into Arabic in 750 BCE, eventually making its way into Europe.\n\n ![Graph](image://088b341d-1932-4fc1-b36a-fcafb84b3652 \"The 'Indian' Method of Nose Reconstruction\")\n\nDuring the Greco-Roman period, a Roman medical writer named Aulus Cornelius, documented procedures very similar to today’s eyelid rejuvenation in a text called *De Medicina*. And later, in the early Byzantine period, a detailed medical encyclopedia titled *Synagogue Medicae* contained various reconstructive techniques dedicated to repair facial defects.","da515343-f869-4a84-bc75-e63f0a344cae",[936,943,950],{"id":937,"data":938,"type":51,"version":24,"maxContentLevel":34},"1d3e5d1b-7c5d-48a8-b0c2-0825145ac994",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":939,"activeRecallAnswers":941},[940],"What is an Indian physician named Sushruta famous for?",[942],"For conducting the first known rhinoplasties (nose reconstructions).",{"id":944,"data":945,"type":51,"version":24,"maxContentLevel":34},"763fee8d-8934-4cc5-bd12-144c074d7cb3",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":946,"activeRecallAnswers":948},[947],"When did an Indian physician named Sushruta live?",[949],"Around 800 BCE",{"id":951,"data":952,"type":51,"version":24,"maxContentLevel":34},"8eda10ba-ac9b-4ef6-9bff-612945d3e30b",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":953,"clozeWords":955},[954],"A Roman medical writer named Aulus Cornelius, documented procedures very similar to today’s eyelid rejuvenation.",[956],"eyelid rejuvenation",{"id":958,"data":959,"type":24,"maxContentLevel":34,"version":24,"reviews":963},"28042664-eeec-460d-8d2b-46ec40aae14d",{"type":24,"title":960,"markdownContent":961,"audioMediaId":962},"Middle Ages and the Renaissance ","During the Middle Ages, developments in plastic surgery stalled, partly due to the spread of Christianity. As science gave way to mysticism and religion, plastic surgery was considered a sign of witchcraft, a view further encouraged by Pope Innocent III who declared that surgery was prohibited by Church Law. \n\nDuring the Renaissance, plastic surgery enjoyed a revival as significant advances in science and technology resulted in safer and more effective surgical techniques. In the 1400s, Italian physician Antonio Braca pioneered his own version of nose reconstruction. Also in the 15th century, Ottoman physician Serafeddin Sabuncuoglu wrote a significant medical book called *Imperial Surgery* which included countless surgical topics. One of them was *gynecomastia*, i.e., enlarged breast tissue in men, and Sabuncuoglu included a treatment protocol for the condition and which is believed to be the foundation of modern-day surgical breast reduction. \n\nIn 1597, Italian surgery and anatomy professor Gaspare Tagliacozzi wrote *The Surgery of Defects by Implantations*, which is considered the first true plastic surgery text. ","c58c5c73-105b-4f22-baeb-6dac6e7a1ec5",[964,971],{"id":965,"data":966,"type":51,"version":24,"maxContentLevel":34},"37db9a5b-0ccf-4db9-9794-32e95f53c351",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":967,"activeRecallAnswers":969},[968],"Why did plastic surgery developments stall during Middle Ages in Europe?",[970],"Because plastic surgery was considered a sign of witchcraft.",{"id":972,"data":973,"type":51,"version":24,"maxContentLevel":34},"465b5570-0c8b-4064-88ac-9d869ba0853b",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":974,"activeRecallAnswers":976},[975],"Who wrote the first true plastic surgery text?",[977],"Italian surgery and anatomy professor Gaspare Tagliacozzi, in the 16th century",{"id":979,"data":980,"type":25,"version":24,"maxContentLevel":34,"pages":982},"104de29e-821d-44d2-a39f-19e52db78cf6",{"type":25,"title":981},"Plastic Surgery in the 20th Century",[983,1004,1019],{"id":984,"data":985,"type":24,"maxContentLevel":34,"version":24,"reviews":989},"ab530b9c-c117-40b0-896e-a9afe8f34220",{"type":24,"title":986,"markdownContent":987,"audioMediaId":988},"World War I","The development of germ theory and the invention of anesthesia in the 19th century contributed to the advancement of plastic surgery, as with most other medical fields. As the world engaged in the First World War, reconstructive surgery became a necessity to treat injured and disfigured soldiers. The scale of head and facial injuries caused by modern weaponry in the battlefield had never been encountered before, and military doctors were required to come up with innovative techniques in facial reconstructive surgery to heal the wounded. \n\nOne of the most prominent plastic surgeons of the time was Dr. Varaztad Kazanjian, sometimes called the founding father of modern plastic surgery, who developed new methods in prosthetic dentistry and maxillofacial surgery. \n\nThe developments of plastic surgery during WWI brought about a new understanding on how someone’s wellbeing can be potentially influenced by their appearance, thus paving the way for a new era in the field and the beginning of aesthetic plastic surgery.","4991a275-55e5-4d7e-8e5a-eedb3850d3ef",[990,997],{"id":991,"data":992,"type":51,"version":24,"maxContentLevel":34},"9858c3ed-20cd-420f-8562-c3be5bcda1aa",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":993,"activeRecallAnswers":995},[994],"Why did the surgeons in early 20th century have to innovate their facial reconstruction techniques rapidly?",[996],"Because the scale of head and facial injuries caused by modern weaponry in the battlefield had never been encountered before.",{"id":998,"data":999,"type":51,"version":24,"maxContentLevel":34},"a843c368-dab2-4292-9e12-1c06d743980a",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1000,"activeRecallAnswers":1002},[1001],"Who is Dr. Varaztad Kazanjian?",[1003],"The founding father of modern plastic surgery",{"id":1005,"data":1006,"type":24,"maxContentLevel":34,"version":24,"reviews":1010},"81cedd71-0316-447c-bda4-86b4bd96fc96",{"type":24,"title":1007,"markdownContent":1008,"audioMediaId":1009},"The 1940s & ‘50s","In the post WWI era, the field of plastic surgery took off. Johns Hopkins University started a plastic surgery training program in 1924, while the American Society of Plastic Surgeons (ASPS) was established in 1931. During WWII, developments in skin grafting methods and the dermatome instrument allowed doctors to treat wounded soldiers with even better results than WWI. \n\nIn 1946, the first issue of the *Journal of Plastic and Reconstructive Surgery* was published, whose goal ever since has been to “inform readers about significant developments in all areas related to reconstructive and cosmetic surgery.”\n\nBy 1950, with board certification in place in the U.S., plastic surgery had become fully integrated in the medical establishment. The ‘50s also brought many innovations in the field, some originating in Korean hospitals as a result of the Korean War. Technique advancement included internal wiring for facial fractures and the use of rotation flaps to correct major facial deformities.","625d5ee7-f68e-4bd5-8ded-deda0eafc9b0",[1011],{"id":1012,"data":1013,"type":51,"version":24,"maxContentLevel":34},"5a71ce13-280b-41e6-ab57-c72319a66b9f",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1014,"binaryCorrect":1016,"binaryIncorrect":1017},[1015],"When was the first issue of the Journal of Plastic and Reconstructive Surgery published?",[581],[1018],"1964",{"id":1020,"data":1021,"type":24,"maxContentLevel":34,"version":24,"reviews":1025},"b7d7096f-5fa1-4b86-b5c1-fee268449fa5",{"type":24,"title":1022,"markdownContent":1023,"audioMediaId":1024},"Modern Plastic Surgery ","In the 1960s, the modern era of plastic surgery started taking shape with silicone, a newly created material, being used by plastic surgeons initially to treat skin imperfections. In 1962, silicone was used as a breast implant for the first time by American surgeons Thomas Cronin and Frank Gerow. \n\nIn the 1980s, public awareness and perception of plastic surgery improved and, with more disposable income due to the economic boom, plastic surgery entered the mainstream. It was also during the ‘80s that the groundbreaking *TRAM flap* technique was developed by Dr. Carl R. Hartrampf, transforming the field of breast reconstruction. TRAM (Transverse Rectus Abdominis Myocutaneous) flap procedure involves moving a small amount of abdominal tissue to the chest in order to rebuild the breast mound.\n\nBy the 1990s, cosmetic procedures such as liposuction and breast augmentation were becoming increasingly popular, albeit among controversy caused around the safety of silicone breast implants. ","26092dcd-09b0-4787-b42c-6bb628a80054",[1026],{"id":1027,"data":1028,"type":51,"version":24,"maxContentLevel":34},"15e1b3ac-09eb-48cf-ae01-91d31da0f1fe",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1029,"activeRecallAnswers":1031},[1030],"What newly created material started to be used by plastic surgeons in 1960s?",[1032],"silicone",{"id":1034,"data":1035,"type":25,"version":24,"maxContentLevel":34,"pages":1037},"fe558f41-8d7b-4c00-a0c2-191bdd04fc59",{"type":25,"title":1036},"Plastic Surgery in the 21st Century",[1038],{"id":1039,"data":1040,"type":24,"maxContentLevel":34,"version":24,"reviews":1044},"b20079f4-d6c7-44be-827b-f59400e6f5d1",{"type":24,"title":1041,"markdownContent":1042,"audioMediaId":1043},"Plastic Surgery in the 21st Century ","The popularity of cosmetic plastic surgery exploded in the 2000s. With celebrity culture on the rise, so are cosmetic procedures. According to ASPS, 15.6 million cosmetic procedures took place in 2020 in the U.S. alone, an increase of 131% from 2000. \n\nIn the wake of the COVID-19 pandemic, skin clinics have reported an increased demand for procedures on the parts of the face showing on camera, such as neck liposuctions and lower facelifts. \n\nHowever, the advancement in reconstructive surgery techniques in the 21st century has also been astounding. In 2005, the first ever partial face transplant took place in France during a 15-hour operation on a woman who had been mauled by a dog. Procedures that were once unthinkable such as double arm transplants and full-face transplants are considered modern-day miracles in a medical field that continues to grow and evolve.","a3f7d43d-3520-4179-83cf-50b8cb4be6ee",[1045,1054],{"id":1046,"data":1047,"type":51,"version":24,"maxContentLevel":34},"0e4df97e-0e58-4db3-9c5e-bd9d72c9a5f1",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1048,"binaryCorrect":1050,"binaryIncorrect":1052},[1049],"Approximately how many plastic surgeries took place in the United States alone in 2020?",[1051],"16m",[1053],"1.6m",{"id":1055,"data":1056,"type":51,"version":24,"maxContentLevel":34},"f3ad2330-4ae3-40da-84ca-e5b204cd25e1",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":1057,"clozeWords":1059},[1058],"In 2005, the first ever partial face transplant took place in France during a 15-hour operation on a woman who had been mauled by a dog.",[1060],"partial face transplant",{"id":1062,"data":1063,"type":27,"maxContentLevel":34,"version":24,"orbs":1066},"582dce03-4bdb-49c6-bbd9-601346583049",{"type":27,"title":1064,"tagline":1065},"Organ Transplantation","Learn about the technical and scientific advancements achieved over the past 70 years that are saving the lives of thousands of patients a year.",[1067,1124,1180],{"id":1068,"data":1069,"type":25,"version":24,"maxContentLevel":34,"pages":1071},"d2e38c91-0eb6-496d-b742-0bcd253c284a",{"type":25,"title":1070},"Introduction to Organ Transplantation",[1072,1086,1102],{"id":1073,"data":1074,"type":24,"maxContentLevel":34,"version":24,"reviews":1077},"872e7125-614b-48ac-810b-9673e1dfaef8",{"type":24,"title":522,"markdownContent":1075,"audioMediaId":1076},"Organ transplantation is “the process of surgically transferring a donated organ to someone diagnosed with organ failure,” a complex multidisciplinary endeavor, requiring the collaboration of various specialties across the medical field including teams of scientists, immunologists, and surgeons. \n\nThe technical and scientific advancements that have been achieved in the field over the past 70 years are today saving the lives of thousands of patients a year, providing them with outstanding long-term quality of life. Continuous innovations and relentless research have transformed what was once impossible into reality, with procedures today ranging from kidney transplants to full facial transplants and everything in between. \n\nWhile this success has required unyielding efforts from scientists and doctors across the board, it has also required pivotal adjustments in the legal framework to accommodate these procedures in a suitable timeframe, as well as vital changes in social attitudes. ","5b8f7ec2-e96c-43ca-850c-19914941cffe",[1078],{"id":1079,"data":1080,"type":51,"version":24,"maxContentLevel":34},"c492f356-0e13-40a0-ba4e-e5df26b5dbdb",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":1081,"clozeWords":1083},[1082],"Organ transplantation is a complex multidisciplinary endeavor, requiring the collaboration of various specialties across the medical field including teams of scientists, immunologists, and surgeons.",[1084,1085],"immunologists","surgeons",{"id":1087,"data":1088,"type":24,"maxContentLevel":34,"version":24,"reviews":1092},"7ae19c60-c159-4691-9ce1-1a11bee20050",{"type":24,"title":1089,"markdownContent":1090,"audioMediaId":1091},"Ancient Times","There are fascinating myths and legends originating from ancient civilizations around the world that refer to body parts being transferred from person to person. Ancient tales in the Greek, Roman, Chinese, Indian and Egyptian cultures describe gods and healers performing organ transplants using animal cadavers. \n\nHowever, the first written reference on skin grafting as a treatment for burns can be found in the *Ebers Papyrus*, which is considered one of the oldest and most extensive records of Egyptian medical history, created around 1500 BCE.\n\n ![Graph](image://a385fb27-ee9e-437c-830c-bef09449527f \"The Ebers Papyrus\")\n\nAround 800 BCE, an Indian physician named Sushruta recorded in detail his advanced technique for full-thickness skin grafts in a text called *Sushruta Samhita*, the first of its kind in ancient history, establishing Sushruta as the father of plastic surgery.","4ab68020-f2aa-495e-9ca1-2405cdaca22d",[1093],{"id":1094,"data":1095,"type":51,"version":24,"maxContentLevel":34},"69042713-56a3-403c-a875-1c3b9b0cafb8",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1096,"binaryCorrect":1098,"binaryIncorrect":1100},[1097],"In what ancient document can we find the first written reference on skin grafting as a treatment for burns?",[1099],"The Ebers Papyrus",[1101],"The Edwin Smith Papyrus",{"id":1103,"data":1104,"type":24,"maxContentLevel":34,"version":24,"reviews":1108},"aad8c965-6504-4a50-90e3-83a2f78eab01",{"type":24,"title":1105,"markdownContent":1106,"audioMediaId":1107},"Notable Early Observations & Attempts ","In the 1500s, Italian surgery and anatomy professor Gasparo Tagliacozzi who wrote *The Surgery of Defects by Implantations*, reconstructed noses and ears using skin from patients’ arms. He observed that using skin from a different donor caused the procedure to fail, thus observing what we now recognize as transplant rejection.\n\nIn the early 1900s, there are records of doctors transplanting kidneys from animals such as monkeys and pigs to patients dying from renal failure. None of these attempts were successful, and patients died within days of the procedures. In 1936, the first human-to-human kidney transplant was attempted unsuccessfully.\n\nIn the 1940s, research in immunosuppression as a method to overcome transplant rejection got under way. British zoologist Peter Medawar carried out transplant research and advanced the theory of acquired immunological tolerance. In 1960, Medawar received the Nobel Prize for Physiology or Medicine for developing the foundation for successful tissue transplantation.","6263efc2-2bdc-4625-8720-7eb7d50cf557",[1109,1117],{"id":1110,"data":1111,"type":51,"version":24,"maxContentLevel":34},"744633d2-296a-4eff-a6f9-abca906a5612",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":1112,"clozeWords":1114},[1113],"In the early 1900s, there are records of doctors transplanting kidneys from animals to humans.",[1115,1116],"animals","humans",{"id":1118,"data":1119,"type":51,"version":24,"maxContentLevel":34},"d8f10043-c141-4574-bb6a-c1e88f2d16e7",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1120,"activeRecallAnswers":1122},[1121],"What is British zoologist Peter Medawar famous for?",[1123],"For developing the foundation for successful tissue transplantation (particularly developing the theory of acquired immunological tolerance)",{"id":1125,"data":1126,"type":25,"version":24,"maxContentLevel":34,"pages":1128},"4412efde-6690-47a6-b4f7-4fa21559e307",{"type":25,"title":1127},"Advancements in Kidney Transplants",[1129,1144,1158],{"id":1130,"data":1131,"type":24,"maxContentLevel":34,"version":24,"reviews":1135},"2771727b-ce0f-471c-a7dd-22dd80fac90a",{"type":24,"title":1132,"markdownContent":1133,"audioMediaId":1134},"Kidney Transplants ","While there had been ongoing research on the viability of transplanting organs, by the 1950s the only successful transplants to have been performed were skin grafts. At the time, the only potential donors were live donors, and so most of the research had been focused on kidney transplants as donors could survive with just one of their own. \n\nEarlier attempts of kidney transplantation had failed because of the incompatibility between donor and host, and the subsequent immune rejection of the transplanted organ by the recipient. However, pioneering research of Sir Peter Medawar on acquired immunological tolerance in the 1940s propelled the concept into reality. \n\nIn 1954, the first successful organ transplant in a human was performed by American physician Joseph Murray who used a kidney from his patient’s identical twin brother. As the brothers were genetically identical, there was no immune rejection from the recipient brother, and both men survived the operation and recovered well.","a150e2ca-1bae-4abc-b6ae-b06bfc11516a",[1136],{"id":1137,"data":1138,"type":51,"version":24,"maxContentLevel":34},"79bfa54e-2010-4b08-83c2-444d9daa01e3",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":1139,"clozeWords":1141},[1140],"The first successful organ transplant in a human was performed in 1954 by American physician Joseph Murray by using the kidney of the patient's twin.",[1142,1143],"1954","twin",{"id":1145,"data":1146,"type":24,"maxContentLevel":34,"version":24,"reviews":1150},"cc4b0a11-97a4-438b-8e10-c9621b919428",{"type":24,"title":1147,"markdownContent":1148,"audioMediaId":1149},"Donor & Recipient: From Twins to Strangers","By the 1950s, intensive and extensive research had highlighted the immune system's crucial role in organ rejection, and scientists were gaining a better understanding around the concept of donor/recipient compatibility. As a result, in 1954, Dr Joseph Murray performed a kidney transplant between twin brothers which was the first ever successful kidney transplant in human history. \n\nIn 1959, the first kidney transplant between individuals not genetically identical was successfully performed in Louisiana. In this case, the donor and recipient were fraternal twin brothers. A year later, a successful kidney transplant between non-twin siblings took place, and, in 1961, the first successful kidney transplant between non-siblings was performed, marking the beginning of a new era. ","3ae7f98e-4c2f-455a-b800-6e70c71d6486",[1151],{"id":1152,"data":1153,"type":51,"version":24,"maxContentLevel":34},"cd4e3064-6c2d-4cb7-9a7e-5a9f0db58b40",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":1154,"clozeWords":1156},[1155],"In 1961, the first successful kidney transplant between non-siblings was performed, marking the beginning of a new era",[1157],"non-siblings",{"id":1159,"data":1160,"type":24,"maxContentLevel":34,"version":24,"reviews":1164},"3b42985e-ee75-4686-bc3f-b1c0b1ceeeb3",{"type":24,"title":1161,"markdownContent":1162,"audioMediaId":1163},"1960s – Kidneys and Beyond ","By the 1960s, it was evident that transplants were feasible between unrelated individuals, so scientists and doctors turned their attention to immunosuppression as a means to prevent rejection. Drugs including azathioprine and prednisone were showing promising results in suppressing the immune system and, in 1962, American doctor Joseph Murray performed the first renal transplant between nonrelated patients using azathioprine. This was also the first successful transplant from a deceased donor. \n\nBy the late 1960s, successful heart, liver, and pancreas transplants from deceased donors had been performed. In 1963, American surgeon James Hardy transplanted the first human lung from a deceased donor. In 1967, Dr. Thomas Starzl performed the first liver transplant in a human, using azathioprine and steroid to suppress the recipient’s immune system and prevent organ rejection.\n\nAnother major development took place in 1968 when the first U.S. organ donor program was established, allowing anyone over 18 to legally donate their organs upon death.","e450a111-41ef-4723-8fcc-2bd62db99456",[1165,1172],{"id":1166,"data":1167,"type":51,"version":24,"maxContentLevel":34},"0deb0d1a-f9c1-4fcc-bcd0-7476323e0858",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1168,"activeRecallAnswers":1170},[1169],"When was the U.S. organ donor program established, allowing anyone over 18 to legally donate their organs upon death?",[1171],"1968",{"id":1173,"data":1174,"type":51,"version":24,"maxContentLevel":34},"cb6cf809-4196-44e0-920b-91032fd78c2e",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":1175,"clozeWords":1177},[1176],"Drugs including azathioprine and prednisone were showing promising results in suppressing the immune system, which enabled organ transplants between strangers.",[1178,1179],"azathioprine","prednisone",{"id":1181,"data":1182,"type":25,"version":24,"maxContentLevel":34,"pages":1184},"999fdb2b-e4ab-49c3-858f-0f9ca1d236d7",{"type":25,"title":1183},"Innovations in Transplant Technology",[1185,1199],{"id":1186,"data":1187,"type":24,"maxContentLevel":34,"version":24,"reviews":1191},"d518909b-e577-4bfd-ba03-a5e26be9355b",{"type":24,"title":1188,"markdownContent":1189,"audioMediaId":1190},"The First Artificial Heart ","In the early 80s, Dr. Robert Jarvik made a groundbreaking invention in the organ transplant field by designing a totally artificial heart at the University of Utah, known as the Jarvik-7. In 1982, Dr. William DeVries and his team successfully implanted the first ever artificial heart in a human during a 7-hour surgery.\n\nThe Jarvik-7 contained two plastic pumps powered by compressed air, which required the patient to be attached to a 350-pound air compressor for the rest of their life. This artificial heart pumped blood through the body at 40-120 pulses per minute and made a soft clicking sound instead of the usual heartbeat sound. \n\nIn the 1990s, the Jarvik-7 was implanted in more than 150 patients whose hearts were too damaged for other interventions while waiting for appropriate donors.\n\n ![Graph](image://72642dee-d740-41e7-998c-c607051269aa \"An Artificial Heart\")","0b3f9bfd-fb7e-4f62-a4d3-bb164197f337",[1192],{"id":1193,"data":1194,"type":51,"version":24,"maxContentLevel":34},"a919d72c-e6e0-40e9-bf68-ec29f0540e49",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1195,"activeRecallAnswers":1197},[1196],"What is the first artificial heart, successfully implanted in 1982, called?",[1198],"Jarvik-7",{"id":1200,"data":1201,"type":24,"maxContentLevel":34,"version":24,"reviews":1205},"69783aef-e087-4023-a00c-b2436163bbf6",{"type":24,"title":1202,"markdownContent":1203,"audioMediaId":1204},"Vascularized Composite Grafting ","By the late 1990s, advanced immunosuppressant drugs further improved transplant tolerance in recipients, allowing for even more complex procedures such as vascularized composite grafts composed of multiple tissues. Vascularized composite grafting is “the transplantation of multiple tissues as a functional unit from a deceased donor to a recipient with a severe injury.” \n\nNoteworthy examples of vascularized composite grafting include the first successful hand transplant in 1998 by Dr. Jean-Michel Dubernard and the first ever full-face transplant successfully performed by Spanish surgeon Juan Barret and his team in 2010.\n\nVascularized composite grafting hailed a new era in the treatment of patients with deformities due to accidents, burns, and other trauma. Prior to that, the only surgical option was facial reconstruction, which had cosmetic and motor function limitations especially for patients with particularly complex deformities.","4816933c-9481-4cdc-bc4f-e57f32e062f6",[1206],{"id":1207,"data":1208,"type":51,"version":24,"maxContentLevel":34},"797a53a8-fab9-483a-bd69-8bdcd2a5cf11",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1209,"activeRecallAnswers":1211},[1210],"What is vascularized composite grafting?",[1212],"It's the transplantation of multiple tissues as a unit.",{"id":1214,"data":1215,"type":27,"maxContentLevel":34,"version":24,"orbs":1218},"0965a6b7-0f5d-4d36-80bf-07cbd336dfa3",{"type":27,"title":1216,"tagline":1217},"Blood Transfusion","Blood transfusion is an indispensable element of modern medicine which saves millions of lives a year. Learn about this incredible treatment and how it has evolved with our understanding of the nature of blood and the circulatory system.",[1219,1304],{"id":1220,"data":1221,"type":25,"version":24,"maxContentLevel":34,"pages":1223},"068230f9-f0c2-4b5c-a2ca-c6255aba0ce3",{"type":25,"title":1222},"The Evolution of Blood Transfusion",[1224,1238,1255,1269,1283],{"id":1225,"data":1226,"type":24,"maxContentLevel":34,"version":24,"reviews":1229},"47291206-6b70-4a7f-af71-18728944605c",{"type":24,"title":522,"markdownContent":1227,"audioMediaId":1228},"Blood transfusion is “the transfer of blood or blood products from one person (donor) into another person's bloodstream (recipient),” and is an indispensable element of modern medicine which saves millions of lives a year, usually in situations where serious blood loss has occurred. \n\nWhile the basic techniques involved in blood transfusion are relatively simple, and the earliest recorded research on blood transfusion dates to the 1600s, the first successful attempt in practice wasn’t until only 200 years ago. This was largely due to the lack of understanding and adequate knowledge on the nature of blood and the physiology of the circulatory system.","446b6693-3d83-43d4-ba0d-c640ae9f5737",[1230],{"id":1231,"data":1232,"type":51,"version":24,"maxContentLevel":34},"dbfb1243-60f2-426f-b6f2-99dbc37d63a3",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":1233,"clozeWords":1235},[1234],"The earliest recorded research on blood transfusion dates to the 1600s, the first successful attempt in practice wasn’t until only 200 years ago.",[1236,1237],"1600s","200",{"id":1239,"data":1240,"type":24,"maxContentLevel":34,"version":24,"reviews":1243},"31cd0c79-a2e6-4d4a-b987-8ec32da3087c",{"type":24,"title":1089,"markdownContent":1241,"audioMediaId":1242},"There is a plethora of ancient tales and written accounts to suggest that people have been fascinated by blood and its significance throughout history, with many cultures recognizing its regenerative properties long before blood transfusion was possible. \n\nIn Homer’s *Odyssey*, written around 700 BCE, Odysseus gave the ‘shades’ in the underworld blood from a sacrificed animal which allowed them to communicate with him. Ancient Egyptians practiced *bloodletting* to cure sick patients, which involved cutting open a vein to release the disease as in those times sickness was simply perceived to be ‘bad blood.’ This practice long continued with the Romans and the Greeks, with Hippocrates theorizing that disease was, in most cases, an imbalance in the blood. \n\nIn those times, as healers began to recognize the importance of blood in one’s health, attempts to replace lost or diseased blood were performed by giving patients blood to drink from a fit and healthy person or animal.","c974ae0f-2906-4fbf-929d-3ab3b8f7a063",[1244],{"id":1245,"data":1246,"type":51,"version":24,"maxContentLevel":34},"98186e01-66b4-49a6-9781-b5ce698c44c1",{"type":51,"reviewType":34,"spacingBehaviour":24,"multiChoiceQuestion":1247,"multiChoiceCorrect":1249,"multiChoiceIncorrect":1251},[1248],"Who is first recorded to use bloodletting to cure sick patients?",[1250],"Ancient Egyptians",[1252,1253,1254],"Ancient Greeks","Ancient Assyrians","Ancient Sumerians",{"id":1256,"data":1257,"type":24,"maxContentLevel":34,"version":24,"reviews":1261},"369e7607-756a-44e3-bb9e-d5ba699325e8",{"type":24,"title":1258,"markdownContent":1259,"audioMediaId":1260},"The Circulatory System","The earliest known written account on the circulatory system can be found in the *Ebers Papyrus*, a compilation of Egyptian medical texts dating back to the 16th century BCE. The text contains an accurate description of the circulatory system, acknowledging the connection between heart and arteries, but is flawed in the belief that it was air circulating through the veins.  \n\nThe first major leap in our understanding of blood that made blood transfusion conceivable wasn’t until the 17th century when British physician and anatomist William Harvey discovered the circulatory system in 1628. Harvey discovered that blood has its own pathway through the body and demonstrated that all of the body’s organs and tissues are supplied by oxygen. He also showed for the first time that the body simultaneously processes oxygen-rich and oxygen-lacking blood without mixing the two.\n\n ![Graph](image://39378b13-8482-48dd-b758-2f94eb09daf8 \"The Circulatory System of the Upper Arm\")","2d23d450-a627-402d-937d-6a88e224a132",[1262],{"id":1263,"data":1264,"type":51,"version":24,"maxContentLevel":34},"00645c83-de59-4608-9e77-9f5ed7f4c3ce",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1265,"activeRecallAnswers":1267},[1266],"Who discovered the circulatory system in 1628?",[1268],"William Harvey, British physician and anatomist",{"id":1270,"data":1271,"type":24,"maxContentLevel":34,"version":24,"reviews":1275},"9ef83e99-1d8b-4c19-8614-8061988e23ab",{"type":24,"title":1272,"markdownContent":1273,"audioMediaId":1274},"The First Blood Transfusions","The accurate understanding of the physiology and function of the circulatory system was demonstrated in 1628 by William Harvey. As a result, the first blood transfusions were attempted in the mid-1600s, though most often unsuccessfully in humans. \n\nIn 1665, British physician Richard Lower performed the first successful blood transfusion from one dog to another, then, in 1667, French physician Jean-Baptiste Denis performed the first ever direct blood transfusion to a human by transfusing blood from a sheep to a sick 15-yr old boy, and later repeated the same to another patient with both surviving. Further attempts though failed and proved fatal.\n\nSoon after, blood transfusions were banned by the French parliament and no longer pursued by the Royal Society in London as they were deemed too dangerous, and the procedure ceased to be used until the mid-19th century.","9fca055c-bddb-4702-ac2c-e87be889e81e",[1276],{"id":1277,"data":1278,"type":51,"version":24,"maxContentLevel":34},"a63fe545-1568-4a08-b155-afa242cbd724",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1279,"activeRecallAnswers":1281},[1280],"What happened to the boy to whom French physician Jean-Baptiste Denis transfused sheep's blood in 1667?",[1282],"He survived (somewhat miraculously!)",{"id":1284,"data":1285,"type":24,"maxContentLevel":34,"version":24,"reviews":1289},"47cb9fe4-0056-4935-b301-b05a92004946",{"type":24,"title":1286,"markdownContent":1287,"audioMediaId":1288},"The 1800s – First Transfusion of Human Blood","The first blood transfusion from one human to another occurred in 1818 by British obstetrician James Blundell at Guy’s and St. Thomas’ Hospital in London. Blundell used blood transfusion on a woman for the treatment of postpartum hemorrhage. Prior to that, and throughout history, a large percentage of women died during childbirth due to the loss of large amounts of blood. \n\nBlundell was successful with his first transfusion using the woman’s husband as donor, and he reported his success and findings in a paper to the Medico-Chirurgical Society of London which was presented on 22 December, 1818. This signaled the beginning of a new era of blood transfusions in modern medicine. \n\nHowever, while Blundell was successful in his first attempt, his subsequent attempts weren’t as positive. He was undoubtedly the first to understand that human blood is needed to be used on other humans, but it wasn’t yet known that there are different blood types, and that a transfusion with the wrong blood type can lead to immune rejection and, often, death.","5d6a9a78-2f65-4adb-a4a9-461353181bc7",[1290,1297],{"id":1291,"data":1292,"type":51,"version":24,"maxContentLevel":34},"4f85bf71-8ddf-4b9a-a6c7-112889a05ecf",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1293,"activeRecallAnswers":1295},[1294],"Where was the first successful human to human blood transfusion conducted?",[1296],"In the Guy’s and St. Thomas’ Hospital in London.",{"id":1298,"data":1299,"type":51,"version":24,"maxContentLevel":34},"917779cf-1208-4de5-a7da-b88513d7bee0",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1300,"activeRecallAnswers":1302},[1301],"Why weren't Blundell subsequent attempts to transfuse blood between two humans successful?",[1303],"Because he did not yet know about the existence of blood groups, and the fact that they could lead to immune rejections.",{"id":1305,"data":1306,"type":25,"version":24,"maxContentLevel":34,"pages":1308},"5924c100-5bdc-444d-8820-eda9a7d6dade",{"type":25,"title":1307},"Scientific Breakthroughs in Blood Transfusion",[1309,1334,1355,1369],{"id":1310,"data":1311,"type":24,"maxContentLevel":34,"version":24,"reviews":1315},"ead832bc-98ea-48d2-8f95-e3d7edece9f5",{"type":24,"title":1312,"markdownContent":1313,"audioMediaId":1314},"The Discovery of Different Blood Types","In 1901, Austrian doctor Karl Landsteiner discovered the existence of different blood groups, and blood transfusion became a safer practice. Landsteiner discovered the A, B, and O blood groups and theorized that *agglutination* (the clumping of particles) occurred when two incompatible blood types were mixed. As a result, he established a blood type classification system based on the unique chemical composition of red blood cells. \n\nTwo years after Landsteiner’s discovery, his colleagues discovered the AB blood group and concluded that all 4 blood groups were mutually incompatible. In 1912, Roger Lee and Paul Dudley White determined that O type blood could be transfused into any other blood type, and that AB recipients could receive blood of any type. In 1907, American surgeon Reuben Ottenberg established the process of patient/donor blood cross-matching prior to a blood transfusion procedure. ","6ca2ca58-8c57-4710-8236-ad6eee3d86a5",[1316,1327],{"id":1317,"data":1318,"type":51,"version":24,"maxContentLevel":34},"a76fc5a1-099c-467f-b672-ef29e7d740f7",{"type":51,"reviewType":34,"spacingBehaviour":24,"multiChoiceQuestion":1319,"multiChoiceCorrect":1321,"multiChoiceIncorrect":1323},[1320],"Which blood group did Karl Landsteiner not know about?",[1322],"AB",[1324,1325,1326],"A","B","O",{"id":1328,"data":1329,"type":51,"version":24,"maxContentLevel":34},"b880abfa-764e-4cd5-a658-99f0f31f8c3a",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1330,"activeRecallAnswers":1332},[1331],"What is the name of the Austrian doctor who discovered the existence of different blood group?",[1333],"Karl Landsteiner",{"id":1335,"data":1336,"type":24,"maxContentLevel":34,"version":24,"reviews":1340},"86d38655-eedb-4da1-81f1-f373c69e840d",{"type":24,"title":1337,"markdownContent":1338,"audioMediaId":1339},"Blood Types – A Brief Description","A person’s blood type entirely depends on the genes they inherited from their parents and the best-known system for categorizing blood types is known as the ABO system. The 4 major blood types are A, B, O, and AB, which are further split into 4 sub-categories: A+/A-, B+/B-, O+/O-, and AB+/AB-. The most common blood type is O+, while the rarest is AB-. \n\nThe differentiation between blood types lies in the *antigens* that are on the surface of the red blood cells. Antigens are protein or sugar molecules which vary from person to person due to genetic differences. The difference in the antigens of each blood type determines the compatibility between blood donor and receiver. Incompatible blood types will launch an immune response from the receiver and lead to rejection of the transfusion. \n\nPeople with O- blood type are considered universal donors as almost anyone with any blood type can receive O- in a transfusion.","dd493400-04f6-4d92-8f13-6646a9d1ad59",[1341,1348],{"id":1342,"data":1343,"type":51,"version":24,"maxContentLevel":34},"679b8888-038e-4f05-9de6-0440f90c0771",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1344,"activeRecallAnswers":1346},[1345],"What is the rarest blood type?",[1347],"AB-",{"id":1349,"data":1350,"type":51,"version":24,"maxContentLevel":34},"ad4ec024-d0cd-4954-a670-6815f60de136",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":1351,"clozeWords":1353},[1352],"People with O- blood type are considered universal donors.",[1354],"universal donors",{"id":1356,"data":1357,"type":24,"maxContentLevel":34,"version":24,"reviews":1361},"05d742d5-94db-4b74-9671-e1486a875a1e",{"type":24,"title":1358,"markdownContent":1359,"audioMediaId":1360},"The Impact of War","Blood transfusions took off in the early 20th century following the fundamental discovery of the different blood groups and which ones were compatible and could safely be mixed. When WWI broke out in 1914, the need for continuous supply of fresh blood to save wounded soldiers led to the creation of blood banks. \n\nEfficient blood banking required methods to allow for longer preservation of blood, which led to the discovery of sodium citrate as a successful chemical with potent anti-clotting properties. Sodium citrate kept blood fresh while refrigerated, which made it possible to store and later transfuse blood from dead soldiers, saving thousands of lives.  \n\nFollowing the successful blood preservation and storage during WWI, the 1920s and ‘30s saw the beginning of voluntary blood donations which could be stored and used as needed, and, by the start of WWII, blood transfusion was a well-established procedure which was used on a large scale to treat thousands of injured soldiers.","c08a809e-f7f2-4fa8-b6b2-f0884c9ab691",[1362],{"id":1363,"data":1364,"type":51,"version":24,"maxContentLevel":34},"1a58eb75-55bb-4ea4-9b2f-6df4a37f70b0",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1365,"activeRecallAnswers":1367},[1366],"Why is sodium citrate used in blood transfusions?",[1368],"It is used when blood is stored in banks, as an anti-clotting agent.",{"id":1370,"data":1371,"type":24,"maxContentLevel":34,"version":24,"reviews":1375},"de107140-6cbb-4c59-b41c-b9dcc8bdc935",{"type":24,"title":1372,"markdownContent":1373,"audioMediaId":1374},"Modern Advances","Today, scientific advances in how the blood works have made blood transfusion safer than ever before. *Nucleic acid amplification testing* (NAT), which is a type of molecular testing, finds active viruses in the donor's blood to determine infection risk. If an active virus is found, then the donor blood is discarded. \n\nFurthermore, advances are being made in avoiding and treating reactions occurring from blood transfusions, including transfusion-related lung injury (TRALI) and transfusion-associated cardiac overload. Researchers have found that modifying the blood prior to transfusion by removing white blood cells can reduce the likelihood of host rejection. \n","42e69e4b-41c3-4635-804f-c603f4617c69",[1376,1383],{"id":1377,"data":1378,"type":51,"version":24,"maxContentLevel":34},"7c312b48-8b8e-4cf6-9cc5-cc82f513f16e",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1379,"activeRecallAnswers":1381},[1380],"What procedure can reduce the likelihood of host rejection of transfused blood?",[1382],"Removing white blood cells",{"id":1384,"data":1385,"type":51,"version":24,"maxContentLevel":34},"aab603d0-b8ef-4934-9a12-4d7dd1d7ef6a",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1386,"activeRecallAnswers":1388},[1387],"Why is nucleic acid amplification testing (NAT) used in blood transfusions?",[1389],"It finds active viruses in the donor's blood to determine infection risk.",{"id":1391,"data":1392,"type":27,"maxContentLevel":34,"version":24,"orbs":1395},"761276b3-7483-476e-b33d-2135e38a8258",{"type":27,"title":1393,"tagline":1394},"Epidemiology","Learn all about the study of diseases in populations, what the difference between endemic, epidemic and pandemic is, and how we identify the important factors.",[1396,1474],{"id":1397,"data":1398,"type":25,"version":24,"maxContentLevel":34,"pages":1400},"d2387ab4-f4d4-4998-8364-2fd2e7d37e86",{"type":25,"title":1399},"Foundations of Epidemiology",[1401,1415,1429,1460],{"id":1402,"data":1403,"type":24,"maxContentLevel":34,"version":24,"reviews":1406},"095789b5-7b63-4e26-9105-46621fbb2876",{"type":24,"title":522,"markdownContent":1404,"audioMediaId":1405},"Epidemiology is the study of diseases in populations, and it examines how, where, and why they occur. The World Health Organization defines epidemiology as: \n\n*“The study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems.”*\n\nThe Greek physician Hippocrates, known as the father of medicine, observed the impact of environmental factors on the occurrence of disease, and is considered to be the first epidemiologist. It may not be surprising that the term ‘epidemiology’ is derived from the combination of the following Greek words: *Epi*, meaning ‘upon, among;’ *demos*, meaning ‘people, district;’ and *logos*, meaning ‘word, study.’  \n\nHippocrates also made the distinction between *epidemic* and *endemic*, distinguishing between diseases that ‘visit upon’ a population (epidemic) from those that ‘reside within’ a population (endemic).","1a402619-ddd6-484d-ac54-9495e27d7320",[1407],{"id":1408,"data":1409,"type":51,"version":24,"maxContentLevel":34},"750d3d05-b8e4-4299-a8c4-5b1ab995efc5",{"type":51,"reviewType":212,"spacingBehaviour":24,"clozeQuestion":1410,"clozeWords":1412},[1411],"Hippocrates also made the distinction between diseases that ‘visit upon’ a population (epidemic) from those that ‘reside within’ a population (endemic). ",[1413,1414],"visit upon","reside within",{"id":1416,"data":1417,"type":24,"maxContentLevel":34,"version":24,"reviews":1421},"af73e4d9-4c2d-47a1-94aa-d308c93c9c6d",{"type":24,"title":1418,"markdownContent":1419,"audioMediaId":1420},"Girolamo Fracastoro ","In the mid-1500s, an Italian physician named Girolamo Fracastoro proposed the first scientific germ theory of disease in *De contagione et contagiosis morbis* (On Contagion and Contagious Diseases) in 1546, around 300 years before it was empirically formulated by Louis Pasteur and Robert Koch. \n\nFracastoro suggested that each epidemic disease is caused by a different type of rapidly multiplying miniscule ‘seed-like entities’ that could be spread in 3 ways: by direct contact; by carriers such as dirty clothes; and through the air. Fracastoro was the first to scientifically explore and understand the true nature of contagion, infection, and disease transmission. \n\n ![Graph](image://873479ab-7d66-48c1-9808-16be65d2d82c \"Girolamo Fracastoro\")\n\n","21301907-3069-482d-a32a-5bf6fcf4e82f",[1422],{"id":1423,"data":1424,"type":51,"version":24,"maxContentLevel":34},"84d0018b-6991-4bea-b761-3514d580156c",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1425,"activeRecallAnswers":1427},[1426],"Who was the first to scientifically explore and understand the true nature of contagion, infection, and disease transmission?",[1428],"Girolamo Fracastoro, an Italian physician in 1500s",{"id":1430,"data":1431,"type":24,"maxContentLevel":34,"version":24,"reviews":1435},"6f604a8b-837d-4a69-8780-432850928c4f",{"type":24,"title":1432,"markdownContent":1433,"audioMediaId":1434},"John Snow ","Modern epidemiology didn’t become an established medical field until 1854 when a cholera outbreak swept the city of London. British doctor John Snow suspected that the cholera bug was being spread though polluted water and noticed that death rates were significantly higher in two areas that were supplied by the Southwark and Vauxhall Water Company. \n\nSnow’s data collection and analysis was unparalleled. He carefully mapped out the outbreak by tracking down 83 victims and collecting details of where they had obtained their drinking water from, linking every single case to a water pump on Broad Street. Snow removed the pump handle as a precaution and the epidemic subsided quickly after that. \n\nSnow remained unrecognized in his time but is today considered the father of modern epidemiology. His methods formed the basis of epidemiological practice in modern medicine and have helped shape public health policies around the world. \n\n ![Graph](image://aee7d32d-d3aa-4790-9462-0d933e5a2300 \"John Snow\")","ee612fbe-5224-411d-8467-02b12b09d5c2",[1436,1443,1451],{"id":1437,"data":1438,"type":51,"version":24,"maxContentLevel":34},"628e73d5-6f9a-4f23-8f99-90d01dd144e0",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1439,"activeRecallAnswers":1441},[1440],"What did John Snow identify as the source of infection in an 1854 cholera epidemic?",[1442],"A water pump on Broad Street",{"id":1444,"data":1445,"type":51,"version":24,"maxContentLevel":34},"d4f913b4-225e-4ce7-b313-ba6cebe0eba5",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1446,"binaryCorrect":1448,"binaryIncorrect":1450},[1447],"John Snow helped curtail the epidemic of what disease in 1854 London?",[1449],"Cholera",[297],{"id":1452,"data":1453,"type":51,"version":24,"maxContentLevel":34},"fef60e6c-3fad-4fd3-bbfe-86fad65fd8f8",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1454,"binaryCorrect":1456,"binaryIncorrect":1458},[1455],"Were John Snow's achievements in epidemiology recognised in his time?",[1457],"No",[1459],"Yes",{"id":1461,"data":1462,"type":24,"maxContentLevel":34,"version":24,"reviews":1466},"191ba9db-a226-419f-af92-7f9ac012737a",{"type":24,"title":1463,"markdownContent":1464,"audioMediaId":1465},"The Emergence of Germ Theory","Louis Pasteur was a French chemist and microbiologist, and the first to experimentally prove the connection between germs and disease in the 1860s. Pasteur’s conclusive experiments served to debunk the theory of *spontaneous generation* – essentially that life arises from non-living mater – that had been dominating the medical field from ancient times. His pioneering studies revolutionized the understanding of diseases and their cause, laying the foundation for modern day treatment.  \n\nWith this shift in paradigm the focus of epidemiologists changed to the causes, consequences, treatment, and prevention of diseases. Following Robert Koch’s discovery that specific germs cause specific diseases, epidemiologists sought to determine the germs responsible for major diseases which, in turn, allowed them to focus on their transmission patterns. ","4dd8acae-4d37-43f3-a1a9-96ae37654042",[1467],{"id":1468,"data":1469,"type":51,"version":24,"maxContentLevel":34},"cbd26d0b-8e0e-45de-9cc5-09a4b386b75d",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1470,"activeRecallAnswers":1472},[1471],"How did germ theory help stimulate epidemiology studies?",[1473],"Now that it was accepted that pathogens caused disease, attention turned to their transmission patterns.",{"id":1475,"data":1476,"type":25,"version":24,"maxContentLevel":34,"pages":1478},"a3165cb4-1c26-4580-aa09-e874af36e133",{"type":25,"title":1477},"Key Concepts in Epidemiology",[1479,1495,1518,1539],{"id":1480,"data":1481,"type":24,"maxContentLevel":34,"version":24,"reviews":1485},"ca5f3420-0bab-41c5-adce-2b5b67ed0ae8",{"type":24,"title":1482,"markdownContent":1483,"audioMediaId":1484},"Clinical Medicine vs Epidemiology","While epidemiology is an entirely different field from clinical medicine, both are closely related and work together in the continuous quest to understand, prevent and treat diseases. Epidemiology is different to clinical medicine as it focuses on infection and disease in a community rather than an individual. In clinical medicine, doctors are concerned with the disease pattern presenting in an individual patient, whereas epidemiologists are concerned with disease patterns in entire populations.  \n\nAn important differentiation is that, while doctors are primarily concerned with disease, epidemiologists are interested in both infection and disease. It is possible to encounter infection that never develops into disease, and so studying clinical illness alone would give an unreliable epidemiological picture and lead to ineffective control and prevention. Similarly, epidemiologists study both the ill and the healthy to get a better understanding of patterns and causes, while doctors only deal with sick patients.","b05778a4-bf27-4b59-94de-91f063ca7c59",[1486],{"id":1487,"data":1488,"type":51,"version":24,"maxContentLevel":34},"cc7ae975-0781-4d87-b760-4c35bb44b13c",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1489,"binaryCorrect":1491,"binaryIncorrect":1493},[1490],"Epidemiology focuses on a disease from what perspective?",[1492],"Community",[1494],"Individual",{"id":1496,"data":1497,"type":24,"maxContentLevel":34,"version":24,"reviews":1501},"5cc23db3-5be2-420b-a72b-5da8a40ff2c7",{"type":24,"title":1498,"markdownContent":1499,"audioMediaId":1500},"Classification of Diseases in Epidemiology","In epidemiology, researchers classify diseases based on their type and frequency of occurrence as being either *endemic* or *epidemic*. Hippocrates was the first to make this distinction in the 5th century BCE. \n\nEndemic diseases are those that are present, contained, and remain fairly consistent within a region or group of people, such as malaria which is endemic to parts of Africa due to the higher temperatures that allow the *Anopheles* mosquito to thrive. In contrast, an epidemic is a sudden spike in occurrence of a disease within a population or region, like the Ebola virus which spread rapidly throughout West Africa in 2014. \n\nAn epidemic can give rise to a *pandemic* which is a sudden rapid outbreak of a disease affecting populations across different geographical regions, such as COVID-19. Scientists determine whether a disease has become a pandemic if it is spreading at a very fast rate with new cases daily. \n\nIt is important to note that the classification of diseases in epidemiology doesn’t describe their severity but rather their prevalence.","6e29c539-2af2-47ac-9f20-4715be39db11",[1502,1509],{"id":1503,"data":1504,"type":51,"version":24,"maxContentLevel":34},"4a174eec-aea3-4174-b483-243318b3be57",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1505,"activeRecallAnswers":1507},[1506],"Who was the first to make a distinction between endemic or epidemic diseases?",[1508],"Hippocrates, 500 BC",{"id":1510,"data":1511,"type":51,"version":24,"maxContentLevel":34},"7eebc9e5-8c63-4845-bce7-80aa95d9aad3",{"type":51,"reviewType":25,"spacingBehaviour":24,"binaryQuestion":1512,"binaryCorrect":1514,"binaryIncorrect":1516},[1513],"What do we call a sudden rapid outbreak of a disease affecting populations across different geographical regions?",[1515],"Pandemic",[1517],"Epidemic",{"id":1519,"data":1520,"type":24,"maxContentLevel":34,"version":24,"reviews":1524},"314c0162-3edd-4782-8d10-384ae0525d57",{"type":24,"title":1521,"markdownContent":1522,"audioMediaId":1523},"Incidence vs Prevalence ","Disease occurrence is measured based on incidence rates and prevalence rates. The incidence rate represents the number of new cases in a population over a period of time, whereas the prevalence rate measures the total number of existing cases of a disease in a population at a given point in time. \n\nIncidence describes the rate of manifestation of a particular disease in a population, while prevalence reflects how widespread a disease is in a population. Furthermore, the incidence rate is essential in evaluating disease control programs and can affect future decisions in medical care. The prevalence rate can indicate the medical and social burden of a disease within a geographic region, and it is useful mostly in with diseases of long duration. \n\nPrevalence rates are dependent on incidence and duration of a disease, so if the incidence rate of a disease is low but the duration long, then the prevalence rate will be high compared to the incidence rate. Equally, if the prevalence of a disease is low due to short duration, then the prevalence rate will be small compared to the incidence rate.","680bda3e-8e8a-4896-8446-79cd60e73756",[1525,1532],{"id":1526,"data":1527,"type":51,"version":24,"maxContentLevel":34},"7eafaea9-8edf-409d-9837-73f5488fd7c4",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1528,"activeRecallAnswers":1530},[1529],"In epidemiology, what is incidence rate?",[1531],"The number of new cases in a population over a period of time",{"id":1533,"data":1534,"type":51,"version":24,"maxContentLevel":34},"c351fb71-c3ed-48f4-9687-5908294db428",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1535,"activeRecallAnswers":1537},[1536],"In epidemiology, what is prevalence rate?",[1538],"The total number of existing cases of a disease in a population at a given point in time",{"id":1540,"data":1541,"type":24,"maxContentLevel":34,"version":24,"reviews":1545},"f47e1e1a-def3-4cd4-9713-1e5465bdc43e",{"type":24,"title":1542,"markdownContent":1543,"audioMediaId":1544},"Epidemiological Modelling ","Mathematical modelling was introduced into the field of epidemiology in the 20th century by scientists Anderson Gray McKendrick and Janet-Leigh Claypon, and has since been fundamental in managing disease outbreaks and informing public health decisions. \n\nEpidemiological models show how infectious diseases progress in an epidemic based on the behavior of the infectious pathogen and the population itself. Such models aim to predict how effective interventions can be by using a set of assumptions and statistics to establish relevant parameters. These models help predict growth and spread patterns of diseases and which interventions should be implemented or avoided, such as social distancing and mass vaccination. \n\nThe complexity of epidemiological models varies, but an important concept is that of *thresholds*, which are a set of values including vector density, contact number, and population size. These thresholds determine whether a disease will remain endemic or become an epidemic and also help determine the R0  number of a disease in a population. The R0 indicates how transmissible a disease is.","f5affa16-7b81-4cc4-be42-c370468b54fd",[1546],{"id":1547,"data":1548,"type":51,"version":24,"maxContentLevel":34},"c7764bab-a91e-4f84-b138-092b3f2fdc05",{"type":51,"reviewType":24,"spacingBehaviour":24,"activeRecallQuestion":1549,"activeRecallAnswers":1551},[1550],"For what are the scientists Anderson Gray McKendrick and Janet-Leigh Claypon famous?",[1552],"Introducing mathematical modeling into the field of epidemiology.",{"left":4,"top":4,"width":1554,"height":1554,"rotate":4,"vFlip":6,"hFlip":6,"body":1555},24,"\u003Cpath fill=\"none\" stroke=\"currentColor\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"2\" d=\"m9 18l6-6l-6-6\"/>",{"left":4,"top":4,"width":1554,"height":1554,"rotate":4,"vFlip":6,"hFlip":6,"body":1557},"\u003Cg fill=\"none\" stroke=\"currentColor\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"2\">\u003Cpath d=\"M12.586 2.586A2 2 0 0 0 11.172 2H4a2 2 0 0 0-2 2v7.172a2 2 0 0 0 .586 1.414l8.704 8.704a2.426 2.426 0 0 0 3.42 0l6.58-6.58a2.426 2.426 0 0 0 0-3.42z\"/>\u003Ccircle cx=\"7.5\" cy=\"7.5\" r=\".5\" fill=\"currentColor\"/>\u003C/g>",1778228386761]