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With a swipe of a pen Monday, Mississippi Gov. Phil Bryant signed into law a bill that prevents women from getting abortions after 15 weeks of pregnancy. His state, effective immediately, now holds the distinction of having the earliest abortion ban in the nation."As I have repeatedly said, I want Mississippi to be the safest place in America for an unborn child," Bryant tweeted this month in anticipation of the bill's passage. Lt. Gov. Tate Reeves echoed that sentiment Monday, tweeting "It's a great day in Mississippi" along with a picture of the signing.Also known as the Gestational Age Act, Mississippi's new law makes exceptions only for medical emergencies or cases in which there's a "severe fetal abnormality." There are no exceptions for incidents of rape or incest.The law also puts physicians on notice. Doctors who perform abortions after 15 weeks will be required to submit reports detailing the circumstances. If they knowingly violate the law, their medical licenses will be suspended or revoked in Mississippi. If they falsify records, they will face civil penalties or be forced to pay fines of up to 0.The measure is just one in a string of efforts to diminish access to abortions in Mississippi, critics say."Abortion is a safe medical procedure and it is a critical part of the broad spectrum of reproductive health care that a woman may use in her lifetime," said Felicia Brown-Williams, Mississippi state director for Planned Parenthood Southeast Advocates, in a statement. "This ban is not only unconstitutional -- it endangers women's health care across our state. If legislators truly cared about women's health, they would be focused on ways to improve access to health care for women, not restrict it."Access to abortions in Mississippi was already highly restrictive.It is among a small handful of states that has one remaining clinic: in this case, Jackson Women's Health Organization. Although Mississippi is among the states with a 20-week ban, up until the enactment of this latest bill, the cutoff time for abortions at the Jackson clinic was 16 weeks. And since hospitals won't perform abortions, the resulting one-week change brought on by this new law is "arbitrary," based on "capricious whim" and a way to "feed political meat" to a political base, said Dr. Willie Parker, board chairman of Physicians for Reproductive Health.Mississippi is the only state in the country that requires physicians who perform abortions to be board-certified or board-eligible obstetrician-gynecologists, a fact that's being challenged in court as unconstitutional by the Center for Reproductive Rights. Parker, an OB/GYN, explained that he could be trained in a plastic surgical procedure and be free to perform that procedure in Mississippi, even though he's not a board-certified plastic surgeon. But a family physician, a surgeon or an internist trained to perform abortions isn't given the same leeway.Mississippi also requires in-person counseling and a 24-hour waiting period before receiving an abortion, which means women must make repeat trips to the facility -- a fact that's especially burdensome for those living outside Jackson. Health plans under the Affordable Care Act, insurance policies for public employees and public funding for abortions can be applied only in cases of rape, incest, fetal impairment or when a life is endangered, according to the Guttmacher Institute.About 2,000 women a year in Mississippi receive abortions, Parker said. The vast majority, 88%, receive them in the first 12 weeks of pregnancy. So by 15 weeks, he estimates, 200 women in Mississippi who should have access to an abortion no longer will.For women living in poverty who need time to gather resources to pay for an abortion and for those outside Jackson who need to find ways to cover additional expenses associated with travel, House Bill 1510 will close the door to a procedure that's been a legal right for women since the passage of Roe v. Wade in 1973.Proponents of the bill, like Mississippi State Rep. Dan Eubanks, argue that this law will do what's best for women."Beyond the obvious debate of trying to save the lives of innocent babies, there is the often less discussed issues that relates to the health of the mother who receives an abortion," Eubanks wrote in an email. "When did looking out for the life, health and overall wellbeing of a child or its mother start getting labeled as extreme in this country?"Eubanks says that the longer a woman carries a child in her womb, "the greater the potential she will suffer from psychological, emotional, and physical damages as an outcome," though that contention is generally disputed by those who advocate for safe access to abortions.The new Mississippi law is expected to be challenged in court.The Center for Reproductive Rights points out that similar efforts in other states -- Arizona, North Dakota and Arkansas -- were shot down on constitutional grounds. And the advocacy group expects that this bill to ban "pre-viability abortion" will similarly be stopped."Mississippi politicians' flagrant assault on reproductive rights will not go unchallenged," said Lourdes Rivera, senior vice president of US programs at the Center for Reproductive Rights, in a written statement. "This bill is dangerous and unconstitutional. The Center is prepared to answer any attempt to undermine 40 years of Supreme Court precedent with the full force of the law." 5500

While officials in Puerto Rico placed the official death toll from last year's Hurricane Maria at 64, researchers from Harvard believe the death toll was actually in the thousands. According to Harvard's study, there were an estimated 4,645 deaths directly or indirectly tied to the hurricane, which struck the island in September. Harvard estimated a mortality rate of 14.3 deaths per 1.000 people from September 20 through December 31, 2017 in Puerto Rico. Harvard said in its study that it believes its estimate is rather conservative due to a "survivor bias."Harvard conducted the study by performing a random survey of 3,299 households in Puerto Rico. "In our survey, interruption of medical care was the primary cause of sustained high mortality rates in the months after the hurricane, a finding consistent with the widely reported disruption of health systems," the study says. "Growing numbers of persons have chronic diseases and use sophisticated pharmaceutical and mechanical support that is dependent on electricity. Chronically ill patients are particularly vulnerable to disruptions in basic utilities, which highlights the need for these patients, their communities, and their providers to have contingency plans during and after disasters."Part of why there the death toll might have been underreported is due to how hurricane-related deaths are counted. In order to have a death counted as storm related, bodies had looked at by a medical examiner, which required a body to be transported to San Juan, or the medical examiner to travel to remote locations. With a lack of electricity and blocked roads, some bodies were likely buried before the government could count fatalities. Maria is considered the third-costliest hurricane in US history.  1816

With a coronavirus vaccine still months off, companies are rushing to test what may be the next best thing: drugs that deliver antibodies to fight the virus right away, without having to train the immune system to make them.Antibodies are proteins the body makes when an infection occurs; they attach to a virus and help it be eliminated. Vaccines work by tricking the body into thinking there’s an infection so it makes antibodies and remembers how to do that if the real bug turns up.But it can take a month or two after vaccination or infection for the most effective antibodies to form. The experimental drugs shortcut that process by giving concentrated versions of specific ones that worked best against the coronavirus in lab and animal tests.“A vaccine takes time to work, to force the development of antibodies. But when you give an antibody, you get immediate protection,” said University of North Carolina virologist Dr. Myron Cohen. “If we can generate them in large concentrations, in big vats in an antibody factory ... we can kind of bypass the immune system.”These drugs are believed to last for a month or more and could give quick, temporary immunity to people at high risk of infection, such as health workers and housemates of someone with COVID-19. If they proved effective and if a vaccine doesn’t materialize or protect as hoped, the drugs might eventually be considered for wider use, perhaps for teachers or other groups.They’re also being tested as treatments, to help the immune system and prevent severe symptoms or death.“The hope there is to target people who are in the first week of their illness and that we can treat them with the antibody and prevent them from getting sick,” said Dr. Marshall Lyon, an infectious disease specialist helping to test one such drug at Emory University in Atlanta.Having such a tool “would be a really momentous thing in our fight against COVID,” Cohen said.Vaccines are seen as a key to controlling the virus, which has been confirmed to have infected more than 20 million people worldwide and killed more than 738,000. Several companies are racing to develop vaccines, but the results of the large final tests needed to evaluate them are months away.The antibody drugs are “very promising” and, in contrast, could be available “fairly soon,” said Dr. Janet Woodcock, a U.S. Food and Drug Administration official who is leading government efforts to speed COVID-19 therapies. Key studies are underway and some answers should come by early fall.One company, Eli Lilly, has already started manufacturing its antibody drug, betting that studies now underway will give positive results.“Our goal is to get something out as soon as possible” and to have hundreds of thousands of doses ready by fall, said Lilly’s chief scientific officer, Dr. Daniel Skovronsky.Another company that developed an antibody drug cocktail against Ebola — Regeneron Pharmaceuticals Inc. — now is testing one for coronavirus.“The success with our Ebola program gives us some confidence that we can potentially do this again,” said Christos Kyratsous, a Regeneron microbiologist who helped lead that work.Regeneron’s drug uses two antibodies to enhance chances the drug will work even if the virus evolves to evade action by one.Lilly is testing two different, single-antibody drugs — one with the Canadian company AbCellera and another with a Chinese company, Junshi Biosciences. In July, Junshi said no safety concerns emerged in 40 healthy people who tried it and that larger studies were getting underway.Others working on antibody drugs include Amgen and Adaptive Biotechnologies. The Singapore biotech company Tychan Pte Ltd. also is testing an antibody drug and has similar products in development for Zika virus and yellow fever.“I’m cautiously optimistic” about the drugs, said the nation’s top infectious diseases expert, Dr. Anthony Fauci. “I’m heartened by the experience that we had with Ebola,” where the drugs proved effective.What could go wrong?— The antibodies may not reach all of the places in the body where they need to act, such as deep in the lungs. All the antibody drugs are given through an IV and must make their way through the bloodstream to wherever they’re needed.— The virus might mutate to avoid the antibody — the reason Regeneron is testing a two-antibody combo that binds to the virus in different places to help prevent its escape.Skovronsky said Lilly stuck with one antibody because manufacturing capacity would essentially be cut in half to make two, and “you will have less doses available.” If a single antibody works, “we can treat twice as many people,” he said.— The antibodies might not last long enough. If they fade within a month, it’s still OK for treatment since COVID-19 illness usually resolves in that time. But for prevention, it may not be practical to give infusions more often than every month or two.A San Francisco company, Vir Biotechnology Inc., says it has engineered antibodies to last longer than they usually do to avoid this problem. GlaxoSmithKline has invested 0 million in Vir to test them.Giving a higher dose also may help. If half of antibodies disappear after a month, “if you give twice as much, you will have two months’ protection,” Lilly’s Skovronsky said.— The big fear: Antibodies may do the opposite of what’s hoped and actually enhance the virus’s ability to get into cells or stimulate the immune system in a way that makes people sicker. It’s a theoretical concern that hasn’t been seen in testing so far, but large, definitive experiments are needed to prove safety.“As best as we can tell, the antibodies are helpful,” Lyon said.___Marilynn Marchione can be followed on Twitter: @MMarchioneAP___The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content. 5919

White House senior policy adviser Stephen Miller has been interviewed as part of special counsel Robert Mueller's Russia probe, according to sources familiar with the investigation.The interview brings the special counsel investigation into President Donald Trump's inner circle in the White House. Miller is the highest-level aide still working at the White House known to have talked to investigators.Miller's role in the firing of FBI Director James Comey was among the topics discussed during the interview as part of the probe into possible obstruction of justice, according to one of the sources.Special counsel investigators have also shown interest in talking to attendees of a March 2016 meeting where foreign policy adviser George Papadopoulos said that he could arrange a meeting between Trump and Russian President Vladimir Putin through his connections. Miller was also at the meeting, according to a source familiar with the meeting.Papadopoulos was recently charged with lying to the FBI about Russian contacts he had during the campaign.Earlier this year, Miller assisted Trump in writing a memo that explained why Trump planned to fire Comey, according to sources familiar with the matter. Eventually that memo was scrapped because of opposition by White House counsel Don McGahn, who said its contents were problematic, according to The New York Times.The Comey dismissal letter -- drafted during a May weekend at Trump's golf club in Bedminster, New Jersey -- has also drawn interest from the Mueller team. Sources tell CNN that White House senior adviser Jared Kushner, who was also in New Jersey that weekend, did not oppose the decision to fire Comey. CNN has reported the special counsel's team is asking questions in interviews with witnesses about Kushner's role in Comey's firing.The Times reported in September that the Justice Department had turned over a copy of the letter, which was never sent, to special counsel Robert Mueller. That memo, according to a source, was very similar to a letter written by Deputy Attorney General Rod Rosenstein that was cited as the reason for firing Comey. Rosenstein's letter criticized Comey's handling of the investigation into Hillary Clinton's private email server.But just days after the firing, Trump said he considered the Russia probe in his decision to fire Comey."In fact when I decided to just do it, I said to myself, I said 'you know, this Russia thing with Trump and Russia is a made-up story, it's an excuse by the Democrats for having lost an election that they should have won'," Trump said about his decision to fire Comey in a May interview with NBC News.Miller was also an early member of Trump's campaign staff, leaving his role as Sessions' communications director in the Senate to join Trump in January 2016.Mueller's team has also talked to key former aides including former White House chief of staff Reince Preibus and former White House press secretary Sean Spicer. They have also interviewed National Security Council chief of staff Keith Kellogg. CNN has previously reported Mueller is also seeking to interview other White House staff including McGahn, communications director Hope Hicks and Kushner aide Josh Raffell.The special counsel's office declined to comment. Miller did not respond to a request for comment. 3334

When he was diagnosed with two autoimmune diseases, Joel Hechler knew he’d be in for a battle. He didn’t realize maybe his toughest one would be with his insurance company.“I think they put the dollars ahead of a patient’s health,” Hechler said. “I don’t think they fully understand the impact the medicine will have on my long-term health and well-being."Hechler suffers from Crohn’s disease and ulcerative colitis, diseases that attack the lining of his digestive tract. Autoimmune conditions like his can’t be cured but, with the right medication, the symptoms can be controlled.  Finding the right medicine can be hard for those suffering from autoimmune diseases. Even if there are scores of drugs on the market, some patients might only respond to one. In Joel’s case, his doctor thought he’d have a better chance trying a drug called Remicade.“I received a letter from my insurance company that denied the Remicade on the basis that I have to try a different drug before I can get to Remicade," Hechler said.Hechler's insurance company, Premera Blue Cross, wouldn’t approve the drug his doctor prescribed because they wanted him to try a cheaper one first.It’s part of a program that health insurers nationwide use called step therapy, requiring that patients try less-costly drugs before “stepping up” to more expensive ones — even if doctors believes the cheaper drug won’t work.Dr. Larry Adler is president of Huron Gastro in Ypsilanti, Michigan and says he spends virtually every day battling insurance companies over step therapy drugs.“They have to fail this medicine first before they get the new drug,” Adler said. “That doesn’t make any sense.”Adler says it's common for patients to get sicker while waiting for step therapy to run its course.In Hechler's case, it took six weeks of fighting with his insurer to convince them that the cheaper drug wouldn’t be effective. As he was waiting, he was getting worse.“It got to the point where I had to be admitted to the hospital,” Hechler said. "I was very, very sick.”Step therapies are used by insurers to try to control skyrocketing prescription medicine costs, says Glen Perry, Director of Pharmacy Contracting and Sales for Blue Cross Blue Shield of Michigan.“These drugs can cost up to 0,000 per year. These are not cheap medications,” Perry said.“It seems like you’re telling patients that, in many cases, your insurer knows what’s best for you, rather than your doctor,” Jones said.“We are trying to provide the most cost effective and safe medication use,” Perry said, adding that when a doctor and insurer disagree over a drug, they can usually resolve the case within a few days without putting a patient at serious risk.“A delay of one or two days I don’t think is really going to make that much of a difference for the medical outcome of the patient," he said.But for many patients, like Phyllis Toole, the delay is longer than a few days.Phyllis suffers from rheumatoid arthritis, a condition where her body attacks her joints. When her doctor wanted to put her on Orencia, her insurance company HAP said she needed to first try a less expensive drug, Humira.But Phyllis’ doctor was worried about possible side effects and thought Humira could be risky.After battling for months, Phyllis says the whole thing made her feel more like a number than a patient. With her doctor and insurer in a standoff, she was forced to rely on samples of the drug she got from her doctor. HAP never approved her prescription.“They’re playing doctor, is what it feels like,” Toole said. “They’re saying this is what you can have for the symptoms you have. It may make you sicker, but this is what you can have.”HAP issued the following statement to Scripps station WXYZ in Detroit: 3800