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Assuming that cell vo- lumes increase with decreasing extracellular osmolarity cheap abana 60pills mastercard, it was concluded that cell volume changes were inversely related to reflectance changes abana 60 pills sale. Electrical stimulation across the tissue or exposure to high potassium concentrations caused decreases in reflectance discount abana 60 pills on line, indicating that stimulation also led to increases in cell volumes discount 60 pills abana overnight delivery. MacVicar and Hochman were the first to apply digital imaging methods to obtain high-resolution synaptic-evoked changes in light transmission through hippocampal brain slices generic abana 60 pills with visa. The authors used this method to conduct a sequence of experiments designed to determine the physiological mechanisms underlying optical changes. Extracellular osmolarity changes In addition to studying normal physiology, brain slice OI holds promise in uncovering mechanisms underlying epileptiform activity. It may be inferred that optical changes are more closely related to epileptiform activity through synaptic hypersynchronization, rather than hyperexcitability. Also, the intrinsic optical signal changes seen in brain slice preparations may reflect mechanisms critical for the generation of synchronized activity (i. This last hypothesis suggests the possibility of apply- ing brain slice OI to screening anti-epileptic drugs. They obtained OI maps of somatosensory, motor, and lan- guage cortex in patients undergoing awake craniotomies for intractable epilepsy. These benefits allow greater accuracy in intraoperatively delin- eating Rolandic and language cortex, identifying interictal epileptiform discharges, pinpointing the onsets of ictal events with precise localization, and directly observing the pathways by which seizure activity spreads. Because OI relies upon physiological cortical activation rather than direct stimulation from external electrical currents, it can facilitate and enhance the intraoperative identification of cortical regions sub- serving cognitive functions. Several sources of artifacts can make the IOS difficult to discern; successful intraoperative OI requires minimizing patient movement, dampening physiologic brain pulsations, and uniform cortical surface illumination. Brain pulsations associated with hemodynamic and respiratory patterns cause spatial shifts during image acquisition making frame-to-frame IOS analysis difficult. Mechanical dampening is achieved by placing a glass plate (4, 9, 16, or 25 cm2) over the cortical surface in the area of interest. This rigid construct has become particularly important during awake craniotomies and during imaging of seizure activity when image acquisi- tion is continuous over 1 or 2 minutes. The incident light is filtered to the desired wavelength (typically using a 695-nm long-pass filter) with the operating theater darkened to minimize artifacts from ambient light sources. By selecting different wavelengths of light through filtering, differential aspects of the IOS, and therefore specific physio- logical processes, may be emphasized. For example, imaging through a 610- or 695-nm filter, as reported in human studies, emphasizes changes in hemoglobin oxygenation. To further minimize movement artifacts, the microscope is mounted to the operating table by a modified microscope base. Initially, a low-power objective is selected to allow for visualization of a relatively large cortical area (25 cm2). During seizure focus localization or © 2005 by CRC Press LLC functional mapping, images are collected at a rate of about 50 Hz over a period of 1 minute. Using software developed by Daryl Hochman, image analysis can then be performed intraoperatively within 2 minutes. During analysis, statistical algorithms are applied to align successive images in order to compensate for residual microscopic movement artifacts. This is particularly important when images are acquired through a high- power objective where small movements are magnified. Despite efforts to minimize movement, ambient light, and thermal artifacts, a small amount of noise in the processed images is difficult to avoid. While open OI has been successfully performed in humans, it remains a research tool and will require further reliability testing and technical modifications before it can become feasible for routine clinical use. Light emitted from the probe was scattered by the surrounding brain tissue (target tissue morphol- ogy and volume estimated as a ¼ sphere with a 100-micrometer diameter) and delivered to a spectrometer through the six light detecting fibers. The measured slopes obtained from reflectance wavelength plots were signifi- cantly greater in white matter (mean of 2. The authors demonstrated that stereotactic near-infrared imaging could detect subcortical white matter–gray matter interfaces during stereotactic localization of deep brain nuclei.

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The rate at was one of the first pharmaceutical agents to be used to which a cure is achieved is determined by several factors discount abana 60pills on line, lower HGH levels in acromegaly generic 60pills abana overnight delivery. However buy cheap abana 60pills line, bromocrip- including the size of the tumor purchase abana 60 pills mastercard, whether or not it has tine is not effective in a majority of cases cheap abana 60pills, and the med- spread outside the pituitary, and the level of HGH before ications octreotide and lanreotide have supplemented its the surgery. These medications are also known as somatostatin pituitary and exhibiting only moderately high HGH analogues. They decrease both the size of HGH-secreting levels, the cure rate can be as high as 80–90%. In mul- with larger tumors, especially those extending out of the tiple studies, they have been shown to normalize HGH pituitary, cure rates with surgery can be reduced to levels in about 50% of cases and show significant tumor 40–60%. The drawbacks to using both Radiation therapy is often a second line choice of octreotide and lanreotide include multiple weekly dosing treatment for acromegaly, especially in patients who have over a 12-month period, as well as acute side effects such not achieved a cure with surgery. Also, long term acromegaly with radiation was used early on in the his- use of these medications results in an increased risk of tory of the condition, with the first report being written in developing gallstones. This medica- acromegaly are increased when compared to the rest of tion does not decrease the amount of HGH secreted from the population. The principal causes of early death are pituitary tumors; rather, it desensitizes other organs of the cardiac disease, strokes, cancer, and respiratory failure. In medical trials, Pegvisomant was well toler- statistics for predicting early mortality, with higher levels ated and resulted in significant symptomatic improve- of post-treatment HGH corresponding to a greater, earlier ment. New The prognosis for patients with acromegaly who York: McGraw-Hill Publishing, 2001. Edward R Rosick, DO, MPH, MS 32 GALE ENCYCLOPEDIA OF GENETIC DISORDERS formation of the embryo where neither parent is a carrier, IAdams-Oliver syndrome or the existence of both genetic and non-genetic causes for the same syndrome. Definition Different mechanisms have been postulated to Adams-Oliver syndrome (AOS) is a condition explain how Adams-Oliver syndrome occurs. They involving the combination of congenital scalp defects include trauma, uterine compression, amniotic band (called aplasia cutis congenita) and a specific type of sequence (a condition resulting from strands of the limb defect. Recently, Adams-Oliver syndrome has been the scalp and skull, and terminal transverse limb defects. There is extreme variability genetic defect causing decreased stability of embryonic in the severity of problems between families with AOS. Genetic profile Demographics There have been both familial and non-familial cases Adams-Oliver syndrome was first described in 1945. The majority of As of 2000, there have been over 125 cases reported in genetic cases have been inherited in an autosomal domi- the medical literature. There does not appear to be any nant manner, but autosomal recessive and sporadic ethnic difference in prevalence of this condition. A difference in the presentation of AOS in the dominant versus recessive form has not been documented. Signs and symptoms Autosomal dominant inheritance means that only Limb defects are the most common occurrence in one abnormal gene copy is required for the disease to Adams-Oliver syndrome, affecting about 84% of occur. The type of limb defect is usually asymmetrical passing it to their offspring is one in two or 50%. There is a wide range of defective gene copies must be inherited, one from each severity in the limb defects, from something minimal parent, for the disease to manifest itself. Persons with like small or missing finger or toenails (called nail only one gene mutation are carriers for the disorder. Other more moderate limb defects that have Adams-Oliver syndrome do not have any symptoms been reported include webbing (syndactyly) of the skin (asymptomatic) and do not know they are a carrier unless (cutaneous syndactyly) or bones (bony syndactyly) of they have had a child with the syndrome. Carrier testing the fingers or toes, claw-hand malformation (ectro- is not available since the gene location is not known at dactly), and brachydactyly (shortened fingers or toes). The liklihood that each member of a couple Brachydactyly is the most common limb defect in AOS. When both parents are carriers for the reces- problem and is present in about 75% of patients with sive type of Adams-Oliver syndrome, there is a one in Adams-Oliver syndrome. In 64% of patients with con- four chance (25%) in each pregnancy for a child to have genital cutis aplasia, there is also an underlying scull the disease.

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In this environment Independent Software Vendors (ISV) and corporate developers implementing HL7 interfaces can write generic and reusable classes generic abana 60 pills without a prescription, subroutines discount 60pills abana otc, and modules consistent with the guidelines set forth by the HL7 standard for Web Services standards in order to handle HL7 message traffic from a potentially unlimited number of connecting applications and services abana 60pills otc. In addition cheap abana 60pills line, this “plug-n-play” environment will take advantage of supporting discovery protocols such as UDDI to break the rigidity of the current hard-coded message routing infrastructures of most Healthcare enterprises” buy abana 60pills with amex. Web Services for sure will play a very important role in the future of HC informatics. Conclusion The healthcare sector is characterized by a continuously growing competition for survival under difficult economic conditions of scarce resources and limited growth with the constant threat of tightened regulations, public scrutiny, and negative media Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Consequently, HC providers are increasingly seeking opportunities in the information technology (IT) field to operate more effectively and efficiently, and to reduce the overall costs of healthcare delivery while improving the quality (Ashry & Taylor, 2000). The HC software community is moving towards the notions of openness (based on officially approved and globally acceptable standards) and modularity to tackle the integration challenge (Blobel & Holena, 1997, p. Open architectures based on officially approved and globally acceptable standards can contribute to interoperability. The high rate of change creates the need for systems that have the ability to evolve and adapt to the new conditions without excessive cost. Modular software design enables best of breed modules—handling emerging and even unpredictable user or unit require- ments—to be gradually added into the systems and successfully glued within the overall, distributed architecture. In order to achieve the above goal, there is a need for a systematic way of developing applications targeting the Applications layer. Such Application Frameworks should make use of the existing standards in order to reap the benefits of the significant work done in the domain, presenting the knowledge that lies within the standards and thus introducing them in daily use. The use of Application Frameworks will result in achieving interoperability within HIS both on a functional and on conceptual level, reinforcing the role Hospital Information Systems play in healthcare. Acknowledgments The authors would like to thank Aggelos Androulidakis and George Karkalis for their contribution to the framework development, as part of the software development and system design team, as well as Miss Chryssa Marinou for her valuable help with English language issues. Requirements analysis as innovation diffusion: A proposed requirements analysis strategy for the development of an integrated hospital information support system [Electronic version]. Proceedings of the 33rd Hawaii International Conference on System Science, Hawaii. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Object-oriented frameworks: Problems & experiences in building application frameworks. DICOM in a Nutshell, Retrieved February 1, 2004, from the Philips Medical Systems Web site ftp://ftp-wjq. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. From hospital information systems to health information systems: Problems, challenges, perspectives [Electronic Version]. Towards a continuous evolution and adaptation of informa- tion systems in healthcare. Proceedings of the 25th Annual International Confer- ence of the IEEE Engineering in Medicine and Biology Society, Cancun, Mexico, September 17-21. The Interface between the GEHR Project and Technical Committee TC/ 251-Medical Informatics of CEN. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Management and Analysis of Time-Related Data in Internet-Based Healthcare 33 ChapterIII Management and Analysis of Time-RelatedData inInternet-Based HealthcareDelivery Chris D. Augusto, University of Ulster at Jordanstown, Northern Ireland Abstract Technological advancements have and will continue to revolutionize the way healthcare is being delivered and the interaction between patients and healthcare professionals. A key component to these changes will be an extension to the utilization of the Internet, further exploiting the extensible and interoperable features it offers. In addition to providing a distributed communications infrastructure, the ability to incorporate within Internet-based systems a means of intelligent data analysis in supporting healthcare management has now become a reality. In this chapter, we provide the rationale for usage of the Internet as a core infrastructure for a holistic approach to distributed healthcare management and supplement this through the identification of the potential role of temporal reasoning in addressing the time relevance of patient centered clinical information.

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Because anemarrhena brings moisture and coolness purchase abana 60 pills on-line, it will bring relief to excessive internal heat and dryness Ulcers of the mouth and/or bleeding gums symptoms such as fever buy cheap abana 60 pills, thirst purchase 60 pills abana free shipping, irritability order 60 pills abana with amex, racing pulse generic abana 60pills otc, cough, bleeding gums, night sweat, insomnia, and hot Anemarrhena can restore moisture in these oral con- flashes. Anemarrhena has been used in herbal combina- ditions that exhibit excessive dryness and inflammation. In fact, there is scientific ev- Chronic bronchitis idence to support its use in the treatment of diabetes. Ani- Laboratory studies have shown that anemarrhena mal studies show that anemarrhena contains two pharma- can effectively eradicate infections caused by Staphylo- cologic agents, mangiferin and mangiferin-7-0-beta coccus aureus, the bacterial strain that often causes lung glucoside, which appear to increase the effectiveness of infections. Anemarrhena has been effectively used to insulin and can lower blood glucose levels. Anemarrhena GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 77 has the greatest effect in mild to moderate diabetic condi- Side effects tions. However, it does not affect glucose levels in nondia- Animal studies show that anemarrhena, when ad- betic conditions. Anemarrhena may be combined with Shi ministered intravenously at only moderate dosage, can Gao (Gypsum) for additional hypoglycemic effects. High dosages reportedly can cause a severe drop in Chemotherapy and radiation side effects blood pressure, respiratory arrest, and even death. Anemarrhena is often effective in relieving severe adverse reactions associated with conventional Interactions chemotherapy and radiation treatments in cancer pa- tients. According to traditional Chinese medicine, x rays Anemarrhena has been known to interact with: used in radiation treatment and drugs used in chemother- • Iron supplements or multivitamin, multimineral sup- apy are considered “heat toxins. But they are also take iron supplements at least two hours before or two toxic to the body, causing excessive build-up of heat in- hours after the herb. Patients should not use iron cooking Menopausal symptoms utensils to make decoctions as they may alter the chem- istry of the herb. Another use of anemarrhena is to treat menopausal symptoms such as insomnia, hot flashes, and irregular Resources periods. New sure conditions in patients with symptoms of Liver-fire York: Philip Lief Group, 1998. It is available as a single ingredient or in combinations in ORGANIZATIONS the following forms: American Association of Oriental Medicine (AAOM). A method often used in traditional Chinese American Foundation of Traditional Chinese Medicine. NCCAM Clearinghouse, PO Anemarrhena should not be used under the follow- Box 8218, Silver Spring, MD 20907-8218. Diuretic—A substance that increases the forma- • vitamin B12 deficiency anemia tion and excretion of urine. Fire—An extremely high internal heat condition • sickle cell anemia characterized by severe dehydration, red eyes, red • aplastic anemia face, constipation, insomnia, and agitation. Causes & symptoms Anemia is caused by bleeding, decreased red blood cell production, or increased red blood cell destruction. Red blood cells, which contain hemo- • ruptured blood vessel globin that allows them to deliver oxygen throughout the • surgery body, live for only about 120 days. When they die, the iron they contain is returned to the bone marrow and used to cre- ate new red blood cells. Anemia can develop when heavy Iron deficiency anemia bleeding causes significant iron loss. It also occurs when Iron deficiency anemia is the most common form of something happens to slow down the production of red blood anemia in the world. In the United States, iron deficiency cells or to increase the rate at which they are destroyed. This condition is less common in older children and types of anemia have been identified. GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 79 • headache • inability to concentrate and/or memory loss • inflammation of the mouth (stomatitis) or tongue (glos- sitis) • insomnia • irregular heartbeat • loss of appetite • nails that are dry, brittle, or ridged • rapid breathing • sores in the mouth, throat, or rectum • sweating • swelling of the hands and feet • thirst • tinnitus (ringing in the ears) • unexplained bleeding or bruising • pica (a craving to chew ice, paint, or dirt) Folic acid deficiency anemia Folic acid deficiency anemia is the most common type of megaloblastic anemia, in which red blood cells are bigger than normal. It is caused by a deficiency of folic acid, a vitamin that the body needs to produce nor- mal cells. Folic acid anemia is especially common in infants This illustration shows the microscope view of normal red and teenagers.

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