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Also synchrotrons is rather complex allergy symptoms and nausea order 5mg cetirizine with visa, although mod- the operation of such facilities is signifcantly more ern computer-based control systems have strongly expensive than that of state-of-the-art conventional mitigated this difculty allergy symptoms light headed cetirizine 10 mg mastercard. The ability to vary the radiotherapy facilities with the same treatment beam energy eliminates the need for an additional capacity allergy treatment for children purchase cetirizine with amex. Both particle therapy are routinely delivering complete systems with equipment manufacturers and research institutes accelerators and all other equipment. Also Sumitomo has started the development of a compact superconducting cyclotron with a 3. Exploiting the 330 MeV maximum proton under development and may in the long run lead energy this accelerator is also suitable for radiosur- to still smaller sized accelerators, in particular for gery and proton imaging. Superconducting isochronous cyclotrons are also The Dielectric Wall Accelerator, based on very being considered for carbon therapy. Laser based acceleration schemes while proton beams are produced by accelerating are developing rapidly and might eventually make molecular hydrogen ions. References The much smaller dimension and footprint of these machines as compared to the synchrotrons [1] U. Applications of particle erated to a variable energy by an independent cavity accelerators in medicine. Medical the S-band booster linac delivered the beam to a accelerators in radiotherapy. First tests have confrmed the feasibil- ity of this scheme, and higher gradient accelerating structures are under development. The beam delivery system is located downstream The main specifcity of particle therapy beam- from the accelerator and is in charge of delivering lines is the capacity to quickly adjust the tune of the the beam, in frst instance to a phantom for qual- several beam energies required for a patient s irra- ity assurance and then to the patient. It interfaces diations (from few seconds between highest/lowest with the upstream system (ex: link with accelerator energies to a 5 mm range change in less than 80 ms). Due the magnetic The beam is transported from the accelerator exit rigidity of protons or carbons ions, the feld of par- to the treatment rooms by standard beamlines as ticle therapy has faced a real challenge. The frst also used in nuclear physics laboratories (dipoles, systems (1960 1990) were based on fxed beam lines quadrupoles, stirrers, beamproflers. The beam forcing the pioneers to innovate (seated position, emittance could be in the range 2 to 5 pi. The beam is switched from one In the 1990s the frst full 360 solution appeared, room to another via a dipole; the beam is thus only called gantry, a big mechanical structure rotat- available for one room at a time. This constraint is ing around the patient (weighing between 80 and acceptable during treatment hours because the time 150 tons). The limits of this technique are that it is not optimal in terms of the conformity of 4. The scatterers spread by modifying the energy of the beam (directly for the originally Gaussian beam into a wide homo- synchrotrons or through energy selection system for geneously distributed beam that is shaped to the cyclotrons) for the diferent slices of the tumour. The dose- The scanning technique is a kind of 3D scanning of depth curve (the so-called Spread-Out Bragg Peak, the treated volume. Constraints are, however, the complexity (speed, number of checks) and the sensitivity towards organ motion. In both methods, non-invasive instrumentation, mainly ionisation chambers, is used to count and monitor the beam. Displacement from the planned position of the mean recorded position for each spot position and mean displacement the lateral and distal penumbras of the beams are from the planned position for all recorded spots at one specifc 26 the important criteria.
Syndromes
Early diagnosis and treatment Adequate nutrition Immunization against respiratory tract infections Reduction of indoor smoke pollution Coughing or sneezing into a cloth allergy symptoms garlic order cetirizine 5 mg without prescription, or turning away from other people 43 Study Session 36 Louse-Borne Diseases: Relapsing Fever and Typhus Study Session 36 Louse-Borne iseases: Relapsing Fever and Typhus Introduction You already learned about the most widespread vector-borne disease in Ethiopia malaria allergy testing joplin mo generic cetirizine 10mg with amex, transmitted by mosquitoes (Study Sessions 5 12 in Part 1 of this Module) allergy shots johns hopkins 10 mg cetirizine free shipping. Two other vector-borne diseases of public health importance in Ethiopia are the subject of this study session. They are caused by different bacteria, but are transmitted by the same vector the human body louse (plural, lice). The diseases are louse-borne relapsing fever and louse- borne typhus, which are classied as febrile illnesses because the symptoms always include high fever. In this study session, you will learn about the causes, modes of transmission, symptoms and methods of prevention of these diseases. This will help you to identify patients and quickly refer them to the nearest health centre or hospital for specialist treatment. You are also expected to report any cases of these louse-borne diseases to the District Health Ofce, so that coordinated action can be taken to prevent an epidemic from spreading in your community. Learning Outcomes for Study Session 36 When you have studied this session, you should be able to: 36. The human body louse (species name, Pediculus humanus humanus) is commonly found in the clothes, bedding and on the bodies of people living in overcrowded and insanitary conditions, where there is poor personal hygiene. When body lice are found, for example in clothes, the articles are said to be louse-infested. The bites cause an allergic reaction in the person s skin, which becomes inamed and itches, causing the person to scratch the area. Lice are transmitted from person to person during close contact and when sharing bedding in which eggs have been laid. It is one of the epidemic-prone diseases that can cause small, or large-scale epidemics anywhere in Ethiopia, with an estimated 10,000 cases annually. The bacteria multiply in the gut of the louse, but the infection is not transmitted to new hosts when the louse bites a healthy person. Instead, humans acquire the infection when they scratch their bites and accidentally crush a louse, releasing its infected body uids onto their skin. The bacteria enter through breaks in the skin, typically caused by scratching the itchy louse bites. After entering into the skin, the bacteria multiply in the person s blood and they can also be found in the liver, lymph glands, spleen and brain. The symptoms continue for three to nine days, while the immune system of the patient makes antibodies that attach to the bacteria and clear them from the blood, and the patient appears to recover. The numbers of bacteria gradually increase, and four to seven days after recovering from the rst episode of fever, the patient relapses, i. Almost all the organs are involved and there will be pain in the abdomen and an enlarged liver and spleen, in addition to the other symptoms. Without treatment with special antibiotics, 30% to 70% of cases can die from complications such as pneumonia and infection in the brain, leading to coma (a state of deep unconsciousness) and death. Precautions should be taken by you and by health workers in the hospital or health centre, to avoid close contact with a patient with relapsing fever, to prevent acquiring the infection. Louse-borne typhus (also known as epidemic typhus, jail fever or tessibo beshita in Amharic) is similar in many ways to relapsing fever.
Citations are slightly different between books on the Internet allergy testing kalamazoo mi cheap 5 mg cetirizine overnight delivery, databases on the Internet allergy testing doctor discount cetirizine 10 mg free shipping, and Web sites allergy treatment without antihistamines discount cetirizine american express, and different in print and electronically depending on if a smaller section is a contribution to or just a part of the whole. As the Internet evolves, a lot of content today is created directly for the Internet, not reformatted from print materials. Materials that started out as books on the Internet have sometimes become more database-like than book-like, searched to find the relevant information rather than read as whole books or chapters. Does it still make sense to follow publisher information for a Web site or book or single database on the Internet with a semicolon, but to end the publisher information for serial databases and retrieval systems with a period? Today Internet resources may not readily provide information on who is responsible for the content, and where that person or organization may be. For example, a site may provide an organization name, but have no indication of where that organization is geographically. Authors can spend hours searching for this information to include it in brackets, or choose the allowable [publisher unknown], [place unknown], etc. Perhaps it is time to rethink the necessary information to identify a cited work today, and to better standardize citations across different media and publication types. Authorship, titles, and dates (content created or published, revised, and cited if on the Internet) are still crucial but what else is essential? In addition, is it possible to apply the same order and punctuation to all references? Print materials are still used and need consideration; however, electronic resources prevail and citing these materials needs to be simplified. Backus / Joyce Backus Associate Director for Library Operations National Library of Medicine Foreword xv Foreword The Internet has fundamentally changed the publishing model that authors, editors and publishers have followed for centuries. Information that took months or years to publish, edit and distribute in print is now produced and available to the public worldwide on an accelerated schedule. Despite changes brought by technology, the need to accurately cite the source of information for scholarly publication remains. And, while the need to cite remains, the challenges of collecting and reporting accurate, lasting citation information have increased tremendously. Electronic publishing creates new issues of impermanence that paper did not present. With this publication, Citing Medicine, the National Library of Medicine strives to provide those charged with capturing an accurate scholarly citation with a guide to do so in this new era of electronic information, both permanent and ephemeral. These same rules and examples can be used for magazines and other types of periodicals. Journal Articles Sample Citation and Introduction Citation Rules with Examples Examples B. Parts of Journal Articles Sample Citation and Introduction Citation Rules with Examples Examples C. Sample Citation and Introduction to Citing Journal Articles The general format for a reference to a journal article, including punctuation: Examples of Citations to Journal Articles 4 Citing Medicine By tradition, the rules for formatting references to journal articles permit greater abbreviation compared to books: Journal references omit information on place of publication and publisher, whereas book references carry these details. This brevity in citing journal articles stems from the need to conserve space in printed bibliographies and the early databases. Following are some important points concerning citing journal articles: Cite the journal name that was used at the time of publication. Too many variations in type styles may actually make the reference harder to read. Running headers or footers may not carry the official title of a journal and date and issue information may be missing from these locations. Citation Rules with Examples for Journal Articles Components/elements are listed in the order they should appear in a reference. An R after the component name means that it is required in the citation; an O after the name means it is optional.
First allergy medicine brand names purchase 5 mg cetirizine otc, contemporary medicine must think through what is involved in professional commitments allergy medicine hungry buy cetirizine with paypal, what is The Hippocratic Oath and Contem porary Medicine 123 necessary for professional identity allergy forecast in tampa florida order cetirizine 10mg otc, and what internal values should be nur- tured by the profession. Second this assessment may draw strength from a critical appreciation of the extent to which, if any, contemporary medical professionalism is rooted in a Hippocratic tradition and morality. Third, the political, economic, and social aspects associated with medicine should be considered in terms of a philosophically enriched understanding of the final analysis of bioethical issues. The major attributes of Hippocratic m orality can be summarized as follows: the first characteris- tic is that Hippocratic medicine is individualistic, that is, the physician acts always in the best interest of the patient, which implies the moral obligation of beneficent and consequently nonm aleficent. The aim of any medical procedure is the good of the patient independently of other factors, such as the ability to pay or the background of the patient (i. Other characteristics include confidentiality (willing- ness to restrain from divulging information); prohibition to practice euthanasia and abortion; refraining from sexual relationships with patients. In a nutshell, Hippocratic m orality describes the physician as a professional whose etiquette reflects the attributes of a gentleman in his relationship with the patients and his family and his colleagues (Nutton, 1997, p. Interestingly, Ludwig Edelstein remarked that the Hippocratic Oath did not reflect consensus in Greek society concerning medical practice but rather the values and ideology of a small portion of Greek physicians: the document originated in a group representing a small segment of Greek opinion. Medical writings, from the time of Hippocrates down to that of Galen, give evidence of the violation of almost every one of its injunctions. This is true not only in regard to the general rules concerning helpfulness, continence and secrecy. Pellegrino strongly stresses the universal validity of the oath: It was in the early Middle Ages that the ethics of the Hippocratic oath were first universalized. The concept of the physician as a reli- gious man Christian, Moslem, or Jew required him to serve the sick as brothers under the fatherhood of God. The oath was cleansed of its pagan references and found its sources refurbished by the human- ism of the great religions. This is the wellspring for much of medical ethics in nineteenth-century Amer- ica (Pellegrino & Thomasma, 1981, p. Hippocratic medicine became widespread throughout the Judeo-Christian world as a Christian- ized version of the Oath was created. In the context of the Christianity of the first centuries, Hippocratic medicine and its ethical teachings was not dismissed simply on the ground that it was worldly wisdom. According to Owsei Temkin, the Hippo- cratic oath in its pagan form was certainly a major document of medical ethics until at least about the end of the fourth century (Temkin, 1991, p. MacKenney pointed out that in the Middle Ages, Hippocratic ideas concerning the conduct of physicians persisted borrowing [much more] from Hippocrates than from Biblical and clerical authorities... From the non- medical viewpoint of lay historians who are interested in pre-Renaissance classicism, the evidence pre- sented is noteworthy. However, some scholars have pointed out that the Oath s historical value is rather problematic. Vivian Nutton likewise remarks that the Oath was rarely men- tioned in Antiquity as a core reference in medical ethics and that it may not have generally sworn until the sixteenth century at the earliest (Nutton, 1995, p. Due to the problems surrounding the authorship of the document, it would go beyond the scope of our analysis. In brief, however, two main theories have been advanced concerning the source of the Oath.
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