Tunnel Of Time

Skies Torn Apart
Prison of present
Can't confine
Visions of tomorrow...
A vintage desire
Penetrates this frost...

This very day,This glorious morning,
I'm up for this,
Everything's against me,
Cause I'm dreaming
I'm willing to succumb myself,
To this earth,
Mountains move,
Time tickles,
And I'm bleeding.

Pedram
painting titled “Hope” by George Frederic Watts

به یاد کشیک های جراحی

البته شنیدن خبر های بد همیشه ناراحت کننده است ولی این بار بیشتر اذیتم کرد. دوست عزیزم که بخش عمده ای ازاینترنی جراحی بیمارستان شریعتی را با هم گذراندیم، تقریبا تمام کشیک ها را با هم بودیم (آن هم چه کشیک هایی !)  ...این بار اوست که غمگین است،این بار اوست که احساس می کند همه چیز را از دست داده است...و این بار نوبت من است که کنار او باشم تا بلکه این زمستان سخت آسان تر به سر آید.../پدرام

Cochrane Review Advises Chemo+RT For Early Hodgkin's

Chemotherapy followed by radiation therapy (RT) is the standard treatment for patients with early-stage Hodgkin's lymphoma, and it should remain so, according to a review published February 16 by the Cochrane Collaboration of Oxford, U.K.

A review of the outcomes of 1,245 patients who participated in five randomized clinical trials, published in the Cochrane Library, sought to answer the question of whether radiation therapy, with its risk of causing secondary cancers from radiation exposure, could be eliminated. The conclusion of the multi-institutional team from Denmark, Germany, and Switzerland was that from a short-term perspective, patients who received both treatments were less likely to die or have local recurrence compared to those who only received chemotherapy.

The clinical trials took place from the 1970s to 2004 and used a variety of chemotherapy agents, as well as diverse doses and types of radiation therapy. Initial responses by patients to treatments were equally effective in eliminating cancer in large part or entirely, according to lead author Christine Herbst, MD, of the department of internal medicine of the University Hospital of Cologne in Germany.
However, data from the meta-analysis identified differences in outcomes when patients were followed between two and 11.4 years. Patients who received the combined treatment were 40% as likely to die compared to those who had chemotherapy alone, and the hazard ratio for tumor control was similar, at 41%. Complete response rates were similar between the treatment groups.
Although adding radiation therapy increased five-year tumor control and overall survival, patients were exposed to radiation doses that could cause secondary cancers 10 to 30 years following treatment, the authors noted. The meta-analysis performed did not evaluate long-term risks.
by : Cynthia E. Keen

This Is Rooney !

درباره ی دانش راستین

برای اکثر اهل فضل دانش وسیله است نه هدف. به همین دلیل است که ایشان هرگز

 کاربزرگی انجام نخواهند داد:زیرا برای انجام کارهای بزرگ،آن که دانش می جوید باید آن را چون هدفی  دنبال کند و هر چیز دیگرو حتی خود هستی را وسیله بداند.زیرا هر چیزی که انسان برای خاطر خود ان چیز به دنبالش نباشد،بی ارزش است :و فضیلت حقیقی تنها آن جا به دست می آید که اثر برای خاطر خودش خلق شده باشد، و نه به عنوان وسیله ای برای نیل به اهداف برتر.بنابراین کسی که برای خوددانش به دنبال کسب آن نباشد ومقصود اصلی مطالعاتش را درگیری با دانش دیگران بسازد،هرگز موفق به خلق اثری حقیقتا باشکوه و اصیل درراه اندیشه نخواهد شد...آرتور شوپنهاور

از کتاب "جهان و تاملات فیلسوف"گزیده هایی از نوشته های آرتور شوپنهاور ترجمه ی رضا ولی یاری

Imaging's Torrid Growth Rate Is Slowing

 Is the era of rapid growth in medical imaging procedure volume over? The volume of advanced imaging services delivered to Medicare beneficiaries decreased in 2009 -- the first decrease in 11 years, according to a study released Wednesday.
Washington, DC-based research and consulting firm the Moran Company found that the volume of advanced imaging services billed within the Medicare system decreased by 0.1% in 2009 compared with 2008, while overall imaging services declined by 7.1% for the same year-to-year comparison.

"It's pretty clear the era of very rapid growth in advanced medical imaging seems to have come to an end at this point in time," said Don Moran, president of the Moran Company. "All the data point to a leveling. It's unclear whether we will see further declines, but the prior growth of these modalities and the advantages they offer to clinicians seems to be peaking."
The study, released today by the Access to Medical Imaging Coalition (AMIC), reviewed Medicare claims data from 1999 through 2009, examining both spending and volume of advanced imaging services, such as CT, MRI, nuclear medicine, and PET, as well as overall imaging services, including mammography.

Declining Volume

The analysis also found that the total volume of mammography screenings decreased by 0.3% in 2009, compared with a 2.8% compound annual growth rate in the past decade. In addition, the total volume of dual-energy x-ray absorptiometry (DEXA) exams fell by 2.2%, while spending on this technique decreased by 16% from 2008 to 2009.
The new findings are comparable to a 2008 analysis of Medicare claims data that showed a 19.2% reduction in Medicare spending on advanced imaging from 2006 to 2007. It also revealed a significantly reduced procedure volume growth rate of only 1.9%, which was less than the overall rate of physician-payment growth.
In addition, a study presented by David C. Levin, MD, and colleagues at the 2010 RSNA meeting found that imaging procedure volume grew at a compound annual growth rate (CAGR) of 1.4% between 2005 and 2008, well down from the 4.1% CAGR experienced between 1998 and 2005.
Imaging industry observers have attributed the slowing growth rate to reimbursement cuts for medical imaging such as those enacted by the Deficit Reduction Act of 2005. The healthcare reform legislation passed in 2010 includes additional reimbursement reductions.
The study shows that "medical imaging has been decimated by these cuts," said Tim Trysla, executive director of AMIC. "The impact of these cuts, even by the government's own estimates, has 'de facto' caused access problems for patients and providers. We are very concerned about choking off the access to these lifesaving technologies."
John Patti, MD, a radiologist at Massachusetts General Hospital in Boston and chair of the American College of Radiology Board of Chancellors, said he and fellow radiologists are concerned with imaging's declining growth rate, because the Medicare population is increasing and the incidence and prevalence of disease remain the same.

Early Diagnosis

"One of the tremendous benefits of advanced imaging over the years is that it has obviated the need for more costly and evasive diagnostic evaluation," Patti said. "This reversal of trend suggests that Medicare patients may not be receiving those appropriate exams and thus the benefit of early diagnosis."
In addition, he said the decrease may have "negative downstream effects on the health of our aging citizens and on the cost of providing the more complex care that may be necessary to treat disease if it is discovered in advanced stages."
One potential victim of the decline is outpatient imaging center owners and operators. Because of reimbursement cuts for outpatient imaging, some physicians have sold or given their imaging activities to hospitals, which are reimbursed at a higher rate under the Hospital Outpatient Prospective Payment System (HOPPS). That scenario, in turn, could lead to less access to advanced imaging services.
In other study data, Medicare spending for advanced imaging services increased by less than half the spending growth for physician services overall. With a 1.2% increase in spending for advanced imaging, compared with 2.6% for services overall, imaging was one of the slowest-growing segments of the physician fee schedule in 2009.


Some Optimism
Despite the volume downturn in 2009, Trysla believes that advanced medical imaging will continue to contribute to patient care. "Medicine will not turn its back on advanced technology, especially with the benefits of early detection of disease, such as Parkinson's disease and cancer," he said. "I think you will see growth through new applications in technology, and medicine will continue to evolve from exploratory surgery toward early and more exact detection."
ACR's Patti also speculated that the dip in growth in 2009 would be temporary. "I don't think there are any physicians who are taking direct care of patients who don't understand the value of advanced imaging," he added. "And, I don't think there are any physicians who are willingly withholding [advanced imaging] from patients."


by : Wayne Forrest

Interview:Heartbeat of Barcelona and Spain

Many have described Barcelona's 5-0 win over Real Madrid last November as the greatest performance ever. Even Wayne Rooney admits that he stood up in his living room and started applauding.

[Xavi's face lights up]. Yeah? Really? Rooney? That makes me proud. Rooney, wow! Rooney is extraordinary, he could play for Barcelona. And before people imagine headlines like "Xavi says Rooney to join Barcelona" – although, I'd love him to! – what I mean is that he's our kind of player. That game was wonderful, the best I've played. The feeling of superiority was incredible – and against Real Madrid! They didn't touch the ball. Madre mía, what a match! In the dressing room, we gave ourselves a standing ovation.
You mention Barcelona's dominance of possession. It's tempting to conclude that we've never seen a team with an identity – for better or worse – as clear as the current Barcelona and Spain teams. It's all about possession. And that's your identity – one that seems to have become dominant.
It's good that the reference point for world football right now is Barcelona, that it's Spain. Not because it's ours but because of what it is. Because it's an attacking football, it's not speculative, we don't wait. You pressure, you want possession, you want to attack. Some teams can't or don't pass the ball. What are you playing for? What's the point? That's not football. Combine, pass, play. That's football – for me, at least. For coaches, like, I don't know, [Javier] Clemente or [Fabio] Capello, there's another type of football. But it's good that Barcelona's style is now a model, not that.
But some claimed Spain were boring at the World Cup. You kept winning 1-0.
That's upside down. It's not that we were boring, it is the other team that was. What did Holland look for? Penalties. Or [Arjen] Robben on the break. Bam, bam, bam. Of course we were boring – the opposition made it that way. Paraguay? What did they do? Built a spectacularly good defensive system and waited for chances – from dead balls. Up it goes, rebound, loose ball. It's harder than people realise when you've got a guy behind you who's two metres tall and right on top of you.
So, what's the solution?
Think quickly, look for spaces. That's what I do: look for spaces. All day. I'm always looking. All day, all day. [Xavi starts gesturing as if he is looking around, swinging his head]. Here? No. There? No. People who haven't played don't always realise how hard that is. Space, space, space. It's like being on the PlayStation. I think shit, the defender's here, play it there. I see the space and pass. That's what I do.
That's at the heart of the Barcelona model and runs all the way through the club, doesn't it? When you beat Madrid, eight of the starting XI were youth-team products and all three finalists in this year's Ballon d'Or were too – Lionel Messi, Andrés Iniesta and you.
Some youth academies worry about winning, we worry about education. You see a kid who lifts his head up, who plays the pass first time, pum, and you think, 'Yep, he'll do.' Bring him in, coach him. Our model was imposed by [Johan] Cruyff; it's an Ajax model. It's all about rondos [piggy in the middle]. Rondo, rondo, rondo. Every. Single. Day. It's the best exercise there is. You learn responsibility and not to lose the ball. If you lose the ball, you go in the middle. Pum-pum-pum-pum, always one touch. If you go in the middle, it's humiliating, the rest applaud and laugh at you.
Your Barcelona team-mate Dani Alves said that you don't play to the run, you make the run by obliging team-mates to move into certain areas. "Xavi," he said, "plays in the future."
They make it easy. My football is passing but, wow, if I have Dani, Iniesta, Pedro, [David] Villa … there are so many options. Sometimes, I even think to myself: man, so-and-so is going to get annoyed because I've played three passes and haven't given him the ball yet. I'd better give the next one to Dani because he's gone up the wing three times. When Leo [Messi] doesn't get involved, it's like he gets annoyed … and the next pass is for him.
You're talking about style over success but not only can they go together, they have to go together, don't they? Arsenal play great football, Arsène Wenger is a hugely respected coach, but they've not won anything for years. Could that happen at Barcelona?
Almost impossible. If you go two years without winning, everything has to change. But you change names, not identity. The philosophy can't be lost. Our fans wouldn't understand a team that sat back and played on the break. Sadly, people only look at teams through success. Now, success has validated our approach. I'm happy because, from a selfish point of view, six years ago I was extinct; footballers like me were in danger of dying out. It was all: two metres tall, powerful, in the middle, knockdowns, second balls, rebounds … but now I see Arsenal and Villarreal and they play like us.
Do you see yourself as a defender of the faith? An ideologue?
It was that or die. I'm a romantic. I like the fact that talent, technical ability, is valued above physical condition now. I'm glad that's the priority; if it wasn't, there wouldn't be the same spectacle. Football is played to win but our satisfaction is double. Other teams win and they're happy, but it's not the same. The identity is lacking. The result is an impostor in football. You can do things really, really well – last year we were better than Inter Milan – but did not win. There's something greater than the result, more lasting. A legacy. Inter won the Champions League but no one talks about them. People discovered me since Euro 2008, but I've been playing the same way for years. It is true, though, that I have grown in confidence and tranquillity. And that comes with success.
Has English football suffered because it embraces a different footballing culture?
It has changed; the style's a bit more technical. But before it was direct, it was about the second ball, the typical No9 was a Crouch or a Heskey and there was no football. Carragher, boom, up top; Terry, boom, up top. I think it's changing: Barry, Lampard, Gerrard, Carrick … they are players who treat the ball well. You see them now and think, Christ, they are trying to play.
Is Paul Scholes the English Xavi?
[Xavi interrupts, almost bursting with enthusiasm] Paul Scholes! A role model. For me – and I really mean this – he's the best central midfielder I've seen in the last 15, 20 years. I've spoken to Xabi Alonso about him. He's spectacular, he has it all: the last pass, goals, he's strong, he doesn't lose the ball, vision. If he'd been Spanish he might have been rated more highly. Players love him.
England seems to mistrust technical players.
It's a pity. Talent has to be the priority. Technical ability. Always, always. Sure, you can win without it but it's talent that makes the difference. Look at the teams: Juventus, who makes the difference? Krasic. Del Piero. Liverpool? Gerrard, or Torres before. Talento. Talento. When you look at players and ask yourself who's the best: talento. Cesc, Nasri, Ryan Giggs – that guy is a joy, incredible. Looking back, I loved John Barnes and Chris Waddle was buenísimo. [Open-mouthed, eyes gleaming] Le Tissier! Although their style was different I liked Roy Keane and Paul Ince together, too. That United team was great – my English team. If I'd gone anywhere, it would have been there.
In England do we overrate physical players? You mention Carragher, Terry …
Whoa! Wait! Be careful. They're fundamental. We've got Puyol. Technically he might not be the best but it's incredible the way he defends. Carragher and Terry are necessary, brilliant, but they have to adapt to technical football [not the other way round]. For me, that comes naturally – or for Messi, Iniesta or Rooney. Others have to work at it. For them it's harder to lift their head up and play a pass – but they have to.
But when a player is offered to a club, the first question is: "how tall is he?"
Have you seen [the Villarreal winger] Santi Cazorla? You think I'm small, he's up to here on me [Xavi signals his chest]. And yet he's brilliant. Messi is the same and he's the best player in the world. Maybe it's the culture, I don't know, but in England you're warriors. You watch Liverpool and Carragher wins the ball and boots it into the stands and the fans applaud. There's a roar! They'd never applaud that here.
Next week you play Arsenal again in the Champions League last 16. Are they different? A kind of Barcelona-lite?
Arsenal are a great team. When I watch Arsenal, I see Barça. I see Cesc carry the game, Nasri, Arshavin. The difference between them and us is we have more players who think before they play, quicker. Education is the key. Players have had 10 or 12 years here. When you arrive at Barça the first thing they teach you is: think. Think, think, think. Quickly. [Xavi starts doing the actions, looking around himself.] Lift your head up, move, see, think. Look before you get the ball. If you're getting this pass, look to see if that guy is free. Pum. First time. Look at [Sergio] Busquets – the best midfielder there is playing one-touch. He doesn't need more. He controls, looks and passes in one touch. Some need two or three and, given how fast the game is, that's too slow. Alves, one touch. Iniesta, one touch. Messi, one touch. Piqué, one touch. Busi [Busquets], me … seven or eight players with one touch. Fast. In fact, [the youth coach] Charly [Rexach] always used to say: a mig toc. Half a touch.
Arsenal-Barcelona always provokes questions about Cesc Fábregas's future.
If I'd ever gone to another club, I'd have been thinking about Barcelona – the link is strong. The same is happening to him. But now there's a problem: now he's expensive. But I think that a footballer ends up playing where he wants. He has to end up here.
That's not what Arsenal fans want to hear and some have accused Barcelona players, you included, of stirring trouble. Last summer there were so many remarks supposedly coming out of Barcelona …
Really? I hardly spoke then. I imagine they wouldn't have liked that. [Xavi pauses, adding quietly, almost shamefacedly] You know, often footballers don't think. We're selfish, we don't realise. I also say it because I'm thinking of Cesc. He wants to come here. Barcelona has always been his dream. But of course he's Arsenal's captain, the standard bearer, a leader. This situation is a putada [bummer] for him. He's at a club that plays his style with Wenger who has treated him well, taught him, raised him. Cesc respects him. If he'd been at, say, Blackburn it might have been easier to leave. Look, the truth is: I want him to come here. Of course. Barcelona have a very clear style and not many footballers fit. It's not easy. But Cesc fits it perfectly.
Would he replace you, though?
I don't see new players as a threat; I don't say "this is my patch". I'm more: "bring them here, let them play". The more talent in the middle, the better. Four or five years ago [people said] me and Iniesta couldn't play together. We can't play together? Look how that one turned out.
Last year, you beat Arsenal comfortably …
Yes, but this year they're much better. I think it's a disadvantage for us that we played last year. They had [too] much respect for us. It was as if they let us have the ball; we always had it, home and away. The game in London could have been a 4-0 we dominated so much – but it finished 2-2. This year will be different.
What was your reaction to the draw?
I was happy. I like the fact that we'll see a great game. Arsenal aren't the kind of team that come to try to putear you [piss you off, break up the game, destroy the match]. If it was Chelsea, you might think Madre mía, they're going to leave the initiative to you, wait deep, close up, play on the break with Drogba and Malouda. But, no, I think Arsenal will want the ball. There will be more of a game. As a fan I'd definitely pay for a ticket to see this game. Manchester United or Chelsea would play in a more speculative way. They would leave us the ball. Arsenal won't.
Does English football attract you? Spanish players always return from there raving about it.
It's incredible. Una pasada. Now that is football. England really is the birthplace, the heart and soul of football. If Barcelona had Liverpool's fans, or Arsenal's, or United's, we'd have won 20 Champions Leagues, hahaha! OK, so that's an exaggeration but I've never seen anything like it. We won 3-1 at Liverpool once and we were both applauded off the pitch. In England, footballers are respected more, the game is more noble, there's less cheating. Every Spaniard who goes loves it – and comes back a better player. If I had ever left it would have been to England.
The final is at Wembley, which makes it even more special for Barcelona, doesn't it? Last year it was special because it was at the Bernabéu but Wembley is the scene of the Dream Team's one European Cup. And this feels like a year in which you are being constantly compared to them …
In 1992, I was 12 and my brothers went but my parents wouldn't let me. I was in tears but it made no difference. I'd love to play at Wembley. It's special for Barça – and for everyone in football. Last year was more morbosa [about the rivalry with Real Madrid, almost a little dirty, titillating]. This year is more nostalgic, more classic. And I'm more of a nostalgic. Me? I'm a romantic.
@Guardian
Photo : Solarpix.com

سه آستانه نشین

دو شب قبل به کتابفروشی سر زدم و کتاب "سه آستانه نشین " را خریدم. این کتاب را دایا جینیس الن در سال 1983  نوشته  وترجمه ی آن را مترجم خوب کشورمان  رضا رضایی انجام داده است.این کتاب مروری است بر آرای بلز پاسکال، سورن کیرکگور و سیمون وی.این کتاب در 164 صفحه و توسط نشر نی منتشر شده است.../پدرام