Showing 1–12 of 167 results
A Clinician’s Guide to Integrative Oncology
n this book, we willرایگان!
n this book, we will use the term ‘Integrative Medicine practitioner’ to denote a practitioner who is qualified in western medicine and at least one other form of complementary medicine (typically this is often nutritional medicine, acupuncture, an/or mind–body medicine). We will use the term complementary medicine’ to denote those systems of medicine and therapies that lie utside of conventional (western) medicine, which onetheless can be complementary to orthodox medical care. It is of course recognised that in defining it as such, we are taking a somewhat Western-centric approach and that in some countries, forms of ‘complementary medicine’ such as Chinese medicine would not be considered ‘complementary’. The term ‘complementary medicine practitioner’ will be used to denote a healthcare practitioner, whose primary qualification is in a form of complementary medicine and who is not qualified in Western medicine.
A Combined Gate Replacement and Input Vector Control Approach for Leakage Current Reduction
Input vector controlرایگان!
Input vector control (IVC) is a popular technique for leakage power reduction. It utilizes the transistor stack effect in CMOS gates by applying a minimum leakage vector (MLV) to the primary inputs of combinational circuits during the standby mode. However, the IVC technique becomes less effective for circuits of large logic depth because the input vector at primary inputs has little impact on leakage of internal gates at high logic levels. In this paper, we propose a technique to overcome this limitation by replacing those internal gates in their worst leakage states by other library gates while maintaining the circuit’s correct functionality during the active mode. This modification of the circuit does not require changes of the design flow, but it opens the door for further leakage reduction when the MLV is not effective. We then present a divide-and- conquer approach that integrates gate replacement, an optimal MLV searching algorithm for tree circuits, and a genetic algorithm to connect the tree circuits. Our experimental results on all the MCNC91 benchmark circuits reveal that 1) the gate replacement technique alone can achieve 10% leakage current reduction over the best known IVC methods with no delay penalty and little area increase; 2) the divide-and-conquer approach outperforms the best pure IVC method by 24% and the existing control point insertion method by 12%; and 3) compared with the leakage achieved by optimal MLV in small circuits, the gate replacement heuristic and the divide-and-conquer approach can reduce on average 13% and 17% leakage, respectively.
A double-blind controlled study of a nonhydroquinone bleaching cream in the treatment of melasma
Background Melasma iرایگان!
Background Melasma is an acquired hypermelanosis predominantly affecting the face of women. It is often recalcitrant to treatment with hypopigmenting agents. Objective To assess the efficacy of a nonhydroquinone cream (Amelan M®) vs. another (Mela-D®) as treatment for melasma. Methods Twenty-two French women with bilateral epidermal and/or mixed melasma were enrolled in a split-faced prospective trial lasting 4 months during summer season weeks. Twelve patients applied once-daily Amelan M® to one side of the face with sun-protective factor 60 UVA sunscreen each morning and Mela-D® once-daily to the other side of the face. Pigmentation was measured objectively using a mexameter and the melasma area and severity index (MASI) were measured subjectively. Results The mean decrease of pigmentation was statistically significant on the MASI with both cream and only with Amelan M with the mexameter. Some adverse side effects were observed. Conclusions Amelan M® is really more effective than Mela D® cream on melasma. Even though some side effects were observed patients preferred the Amelan M-treated side.
A New Approach to Stone-reliefs of Persepolis
In the north easternرایگان!
In the north eastern part of the Persian Gulf in Iran, there is a region called Fars today and Parse in the past. In this mountainous region there is a mountain previously called Mehr (love) and now called Rahmat (Mercy) with a 2500 years old ruined palace still dazzling on its skirts, remaining from the Achaemenid reign over Iran from c.550 to 330BC. Despite considerable research on the religion of this dynasty, Iranologists have not still conclusively reached a definite opinion on this matter and if they have, it is based on questionable evidences and interpretations. Based on remaining inscriptions and stone-carvings of this monument, the article is an attempt to show that the kings of this dynasty were definitely followers of Zoroaster, who founded the first official religion of the world 6 to 7 centuries AD, with all the symbols found in this unique palace having Iranian roots which so far have wrongly been attributed to the beliefs of other peoples and civilizations.
A practical, algorithmic approach to diagnosing hair shaft disorders
The hair shaft is aرایگان!
The hair shaft is a unique structure composed of an inner cortex and a protective outer cuticle. Any defects in this normal structure due to genetics or the environment can lead to variations in physical properties. Thus one should suspect a hair shaft disorder if a patient presents with an abnormality or change in hair texture, appearance, manageability or ability to grow hair long. A key feature of the clinical evaluation is to determine whether there is hair breakage (increased fragility) by looking for broken hairs and performing a tug test. Once this determination is made, an algorithmic approach can be used to narrow the differential diagnosis: hair shaft disorders with and without fragility. A hair mount along with other directed questions and examination will almost always allow the clinician to make an in-office diagnosis. Common case scenarios, photographs, and practical tips are provided to illustrate the use of this algorithmic approach in the diagnosis of hair shaft disorders. We have also included a summary of the molecular defects where known, which can be helpful in providing a correlation with clinical findings, in counseling patients, and potentially offering treatment options.
A Relational Approach to Conceptualization, Assessment, and Treatment
This book outlines oرایگان!
This book outlines our unique conceptualization of perfectionism, as well as assessment and treatment approaches for it. It represents the culmination of over two decades of research and clinical work on this topic. Our primary purpose for writing this book is to offer insight into the complex construct of perfectionism—not only as a personality style involving traits and relational elements, but also as a clinically relevant personality vulnerability factor that predisposes individuals to myriad problems. We also provide information on appropriate assessment and treatment of those people who are paying a signifcant personal price for their perfectionism.
Abnormalities in the Adrenergic Control and the Rate of Lipolysis in Isolated Human Subcutaneous Adipose Tissue in Diabetes Mellitus
Subcutaneous adipose tissue was obtained from 9 patients with untreated diabetes mellitus and from 13 obese nondiabetics. After incubation with isoprenaline or noradrenaline, glycerol release and tissue cyclic AMP (cAMP) were determined. Basal glycerol release was twice as rapid from the diabetic adipose tissue. With isoprenaline, the cAMP concentration and the glycerol production was significantly higher in the diabetic adipose tissue. Noradrenaline did not increase glycerol production or cAMP concentration in the diabetic adipose tissue. Subcutaneous adipose tissue was also removed from the diabetics after antidiabetic treatment. Basal lipolysis was significantly reduced and noradrenaline significantly increased both glycerol release and cAMP production. With isoprenaline, cAMP production and glycerol release were significantly less after antidiabetic treatment than in the untreated state. The data provide evidence for increased a- as well as fl-adrenergic receptor sensitivity in human subcutaneous adipose tissue of untreated diabetic patients.
Absolute Neurocritical Care Review
Which of the followiرایگان!
Which of the following is the most common form of incomplete spinal cord injury? A. Central cord syndrome B. Cauda equina syndrome C. Anterior spinal cord syndrome D. Posterior spinal cord syndrome E. Brown-Sequard lesion 2. A 64-year-old male with a history of chronic alcohol abuse and congestive heart failure is currently recovering from excision of a large right shoulder lesion suspicious for melanoma. Postoperatively, he is experiencing bleedingand oozing from his surgical site that has persisted despite suture repair and direct pressure for an extended period of time. His labs are drawn, and are as follows: platelets 141 × 103/mL, INR 1.2, fbrinogen 90 mg/dL. Which of the following blood products should be administered next ? A. Fresh frozen plasma B. Cryoprecipitate C. Prothrombin complex concentrate D. Recombinant activated factor VII E. Aminocaproic acid 3. A 75-year-old, 90 kg male with a history of peripheral vascular disease, coronary artery disease, and epilepsy following a recent cerebral infarction presents to the emergency department after having three witnessed seizures at home. He was intubated at the scene by the paramedics, and received 8 mg of intravenous lorazepam and 1 g of phenytoin. While you are evaluating him, he has another generalized tonic-clonic seizure, and the nurse asks if you would like to initiate a continuous propofol infusion. His blood pressure is 94/42 mmHg, and he is having numerous premature ventricular contractions (PVCs) on the electrocardiographic monitor. He has no history of platelet or liver dysfunction. Which of the following should be performed next? A. Complete the phenytoin load to attain 20 mg/kg, then start propofol infusion B. Complete the phenytoin load to attain 20 mg/kg only C. Administer valproate, 30 mg/kg over 10 min, as well as midazolam 0.2 mg/kg D. Start immediate midazolam infusion at 2 mg/kg/h E. Give a 1 L normal saline bolus, and start a norepinephrine infusion to normalize blood pressure 4. A 38-year-old male is brought to the emergency department after a motor vehicle accident. He is found to have signifcant ecchymoses on his chest and face, with multiple apparent rib fractures. He is in mild respiratory distress, with an oxygen saturation of 89% on room air, and hypotensive, with a systolic blood pressure of 88 mmHg. He has absent breath sounds on the right side. There is currently a delay in obtain a bedside portable chest x-ray. Which of the following should be performed next? A. 28-French chest tube placement B. 16-French chest tube placement C. Obtain computed tomography (CT) of the chest D. Administer 30 cc/kg crystalloid E. Obtain urgent cardiothoracic surgery consult
Academic Promotion for Clinicians
Medical schools in tرایگان!
Medical schools in the United States have approximately 166,000 faculty members (Fig. 1.1). The vast majority, about 121,000 (73%) individuals, are physicians, but faculty appointments are also held by many other health professionals .These clinicians have chosen academic practice despite the many career opportunities available in health care. In addition to the individual faculty member, many others including patients, learners, colleagues, institutions, and society have investments in clinicians enjoying long and productive careers in academic medicine. Unfortunately, the evidence points to widespread and deepening dissatisfaction with academic careers. While escalating demands for patient care and educational services are major factors in faculty dissatisfaction, the systems for academic promotion are part of the problem.
Acute Abdomen: Clinical Assessment and Decision-Making
An acute abdomen isرایگان!
An acute abdomen is usually defined as an acute abdominal pain of short duration which requires a decision on whether to proceed or not with urgent intervention . All abdominal crises present with one or more of five main symptoms or signs: pain, vomiting, abdominal distension, muscular rigidity, or shock. The severity and the order of occurrence of the symptoms are important for diagnosis, together with the presence or absence of fever, diarrhea, constipation, and others . The presence of tenderness on palpation is a hallmark of potential acute abdominal problem of surgical importance, and it generally implies inflammation of the visceral peritoneum. This tenderness may be accompanied or not by muscular rigidity (defense guarding or guarding). There are several grades of muscular rigidity, and its elucidation is not always easy on clinical exam, with the exception of the board-like rigidity typical of perforated ulcer. This guarding usually implies inflammation of the parietal peritoneum. Sometimes it takes a great deal of clinical acuity and experience to differentiate between voluntary and involuntary guarding. Modern abdominal imaging, interventional radiology, a better understanding of the natural history of many acute conditions, and more effective ntibiotic treatments have revolutionized emergency abdominal surgery and certainly improved our decision- making capabilities.
Acute Care General Surgery
Patients who presentرایگان!
Patients who present with emergency general surgical problems often have profound physiologic derangements that require immediate correction and stabilization prior to planning a diagnostic approach. This varies from the classic approach we were taught that culminates in history taking, formulating a differential diagnosis, obtaining laboratory and imaging studies, and initiating treatment. The acute care surgeon should be aggressive, take ownership, and promptly begin treatment often without having all the information in these situations. The goal is to correct life-threatening physiology either concurrently or prior to definitive anatomic correction which can be delayed.
Acute Care General Surgery
A 70-year-old womanرایگان!
A 70-year-old woman presents to the emergency department complaining of right lower quadrant pain for 4 days. Her examination shows a palpable mass in the right lower quadrant. A CT scan shows a large distended appendix measuring 4 cm in diameter, without periappendiceal fat stranding (Fig. 1.1). The diagnosis of appendiceal mucocele is made. An open appendectomy is performed without spillage of any contents. Pathology revealed mucosal hyperplasia without signs of atypia. The patient was scheduled for routine post-appendectomy follow up.