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The overall sensitivity in 3-D acquisition is four to eight times higher than in 2-D acquisition purchase diltiazem 180mg with mastercard. Transverse resolution is worse at the center of the field of view than away from the center purchase diltiazem 180mg on-line. Positron Emission Tomogra- References and Suggested Readings 207 phy and Autoradiography: Principles and Applications for the Brain and Heart discount diltiazem 60mg without a prescription. Instrumentation for positron emission tomography: Tomographs and data processing and display systems purchase 180 mg diltiazem overnight delivery. This chapter describes the method of calculating absorbed doses in various organs from radionuclides ingested internally either purposely (e purchase 180mg diltiazem overnight delivery. Radiation Units Three units of measure are related to radiation: the roentgen (R) for expo- sure, the rad (radiation absorbed dose) for absorbed dose, and the rem (roentgen equivalent man) for dose equivalent. Because of practical limitations of the measuring instruments, the R unit is applicable only to photons of less than 3MeV energy. It is a measure of the energy deposited per unit mass of any material by any type of radiation. It should be understood that the rad is independent of the weight of the material. However, the integral absorbed dose is given in units of gram-rad (g·rad or g·Gy) and calculated by multiplying the rad (Gy) by the mass of mate- rial. The dose equivalent unit, rem, has been developed to account for the dif- ferences in effectiveness of different types of radiation in causing biologi- cal damage. It is defined as the ratio of the dose of a standard radiation to produce a par- ticular biological response to the dose of the radiation in question to produce the same biological response. When a radiation dose comes from several radiations, the total dose equivalent is calculated by adding the absorbed doses from individual radiations multi- plied by the Wr of each radiation. In the past, the Wr values were called quality factors, which are somewhat different from the Wr values. Information concerning the biodistribution of ingested radioactivity can be obtained from various experimental studies in humans and animals. The factors 4 and 5 are variable from one individual to another and, therefore, they are approximated for a “standard” or “average” 70-kg man. Radiopharmaceuticals administered to patients are distributed in differ- ent regions of the body. A region of interest for which the absorbed dose is to be calculated is considered the “target,” whereas all other regions con- tributing to the radiation dose to the target are considered “sources. Radiation Dose Rate Suppose a source volume r contains A mCi of a radiopharmaceutical emit- ting several radiations. If the ith radiation has energy Ei and a fractional abundance Ni per disintegration, then the energy absorbed per hour (dose rate) by a target of mass m and volume v from the ith radiation emitted by the source volume r is given by Ri(rad/hr) = A/m(mCi/g)N Ei i(MeV/disintegration) × [3. For penetrating radiations, total or part of the radiation energy may be absorbed in the absorbing material. If the target and the source are not the same, then a factor must be introduced to account for the partial absorption, if any, of the radiation energy. Internal Radiation Dosimetry Here fi(v ← r) is called the absorbed fraction and is defined as the ratio of the energy absorbed by the target volume v from the ith radiation to the energy emitted by the ith radiation from the source volume r. This is a crit- ical factor that is difficult to evaluate, because the absorbed fraction fi depends on the type and energy of the radiation, the shape and size of the source volume, and the shape, composition, and distance of the target volume. However, in the case of b-particles, conversion electrons, a-parti- cles, and x- and g-rays of energies less than 11keV, all of the energy emitted by a radionuclide is absorbed in the volume r larger than 1cm. For x- and g- rays with energies greater than 11keV, the value of fi decreases with increasing energy and varies between 0 and 1, depending on the energy. It should be pointed out that since b-particles are emitted with a distribution of energy, the average energy Eb of b-particles is used in the calculation of Di. If Ao is the initial administered activity, then the activity localized in an organ is a fraction f of Ao. Cumulative Radiation Dose The cumulative radiation dose Di to the target due to the ith radiation of the radionuclide during the period t = 0 to t can be obtained by integrating Eq. Thus, t −l t D rad Δ f ← e i ∫ 0 Dose Calculation 213 1 −let = fA Δ f ← r 1− e le −let = 14.

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Time of onset of diarrhea is variable buy 60 mg diltiazem amex, and diarrhea may develop weeks after using an antibiotic buy generic diltiazem 60mg. Most commonly buy generic diltiazem 60 mg, diarrhea begins within the first week of antibiotic administration generic diltiazem 180mg free shipping. Unusual presentations of this disease include acute abdominal pain (with or without toxic megacolon) 60 mg diltiazem with visa, fever, or leukocytosis with minimal or no diarrhea (103). On occasion, the presenting feature may be intestinal perforation or septic shock (104). Diagnosis can be made by the less sensitive (*67%) rapid enzyme immunoassay or a more sensitive (*90%) but slower tissue culture assay (106). The finding of pseudomembranes on sigmoidoscopy is also diagnostic and can negate the need for exploratory laparotomy. For many years, oral metronidazole was the agent of choice for most patients requiring treatment. A recent study demonstrated that using oral vancomycin is more effective in seriously ill patients (107). Consequently, it is now recommended that any patient requiring intensive care should be treated with enteral vancomycin if she has leukocytosis! Metronidazole is the only agent that may be efficacious parenterally (108); vancomycin given intravenously is not secreted into the gut. In especially severe cases, patients can be treated with the combination of high-dose intravenous metronidazole and nasogastric or rectal infusions of vancomycin. Although therapy with other agents such as intravenous immunoglobulin and stool enemas has been promulgated, this approach has not been compared directly to other standard regimens. When possible, the intensivist should employ the fewest number of antibiotics necessary, choosing those least likely to interact with other drugs and cause adverse reactions. The authors gratefully acknowledge intensivists Lori Circeo, Thomas Higgins, Paul Jodka, and especially Gary Tereso for helping us identify the most important adverse reactions and drug interactions affecting critically ill patients and Pauline Blair for her excellent assistance preparing this review. Brown is on the speaker’s bureaus of Merck, Ortho, Pfizer, and Cubist pharmaceuticals. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. Nature and extent of penicillin side-reactions with particular reference to fatalities from anaphylactic shock. Safe use of selected cephalosporins in penicillin-allergic patients: a meta- analysis. Incidence of carbapenem-associated allergic-type reactions among patients with versus patients without a reported penicillin allergy. Brief communication: tolerability of meropenem in patients with IgE-mediated hypersensitivity to penicillins. Acute renal failure in critically ill patients: a multinational, multicenter study. Double-blind comparison of the nephrotoxicity and auditory toxicity of gentamicin and tobramycin. Prospective evaluation of the effect of an aminoglycoside dosing regimen on rates of observed nephrotoxicity and ototoxicity. Larger vancomycin doses (at least four grams per day) are associated with an increased incidence of nephrotoxicity. Linezolid for the treatment of multidrug resistant, gram-positive infections: experience from a compassionate-use program. Anti-infective drug use in relation to the risk of agranulocytosis and aplastic anemia: a report from the International Agranulocytosis and Aplastic Anemia Study. Incidence of b-lactam-induced delayed hypersensitivity and neutropenia during treatment of infective endocarditis. High frequency of linezolid-associated thrombocytopenia and anemia among patients with end-stage renal disease. Enhanced bleeding with cefoxitin or moxalactam: statistical analysis within a defined population of 1493 patients.

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But in sleep the opposite happens: then it is even the case that small movements appear to be great diltiazem 180mg. This is evident from what often happens during sleep: people think that it is lightning and thundering buy diltiazem 60 mg line, when there are only faint sounds in their ears buy generic diltiazem 180 mg line, and that they are enjoying honey and sweet flavours when a tiny bit of phlegm is running down their throats generic 180 mg diltiazem with visa, and that they go through a fire and are tremendously hot when a little warmth is occurring around certain parts of the body 180mg diltiazem otc. But when they wake up, they plainly recognise that these things are of this nature. Consequently, since of all things the beginnings are small, it is evident that also of diseases and of other affections which are going to occur in the body, the beginnings are small. It is obvious, then, that these are necessarily more clearly visible in sleep than in the waking state. If the dream is correctly interpreted, it can be reduced to its cause, which can be recognised as the cause of an imminent disease. Aristotle pays no attention to the rules for such a correct interpretation of dreams; he only analyses the causal structure of the relationship between the dream and the event foreseen in it. The first is one of the corner stones of his theory of dreams as set out in On Dreams (460 b 28ff. This principle is demonstrated by means of a number of examples derived from common experience (no. The second principle is that the origins of all things (including diseases) are small and therefore belong to the category of small movements. The two principles are combined in the form of a syllogism at the end of the paragraph. These points are most relevant for an assessment of what Aristotle is do- ing in the passage under discussion. It has, of course, long been recognised by commentators that the sentence 463 a 4–5 may very well be a reference to the Hippocratic treatise On Regimen, the fourth book of which deals with dreams and which I quoted at the beginning of this chapter. Although the Hippocratic Corpus contains several examples of the use of dreams as prognostic or diagnostic clues,49 we nowhere find such an explicit theoret- ical foundation of this as in this book. It is chronologically possible and plausible that Aristotle knew this treatise, because other places in the Parva naturalia show a close similarity of doctrine to On Regimen. Moreover, the author’s approach must have appealed to Aristotle for the very fact that the interest of dreams is that they reveal the causes of diseases. However, these similarities should not conceal the fundamental differ- ence of approach between the medical writer and Aristotle. This difference not only manifests itself in that Aristotle, as a natural scientist, is only inter- ested in the causal relationship between the dream and the event, whereas On Regimen is primarily a text about regimen (both from a preventive and from a therapeutic point of view), which explains the great amount of de- tailed attention paid to the interpretation of the contents of dreams and to prescriptions about preventive dietetic measures. The most important difference lies in the psycho-physiological explanation of the significance of dreams given by the two authors. The author of On Regimen appeals to a rather ‘dualistic’ conception of the relation between soul and body, of the type referred to earlier on in this chapter: 49 SeetheinstanceslistedinvanderEijk(1994)279. Ross (1955) 56–7, who points out that Aristotle’s ‘comparison of the heart-lung system to a double bellows [in De respiratione 480 a 20–3] is clearly borrowed from Vict. Aristotle on sleep and dreams 199 For when the body is awake, the soul is its servant: it is divided among many parts of the body and is never on its own, but assigns a part of itself to each part of the body: to hearing, sight, touch, walking, and to acts of the whole body; but the mind is never on its own. However, when the body is at rest, the soul, being set in motion and awake, administers its own household and of itself performs all the acts of the body. For the body when asleep has no perception; but the soul, which is awake, cognises all things: it sees what is visible, hears what is audible, walks, touches, feels pain, ponders, though being only in a small space. Whoever, therefore, knows how to interpret these acts correctly, knows a great part of wisdom. It would be impossible for Aristotle to say – as the writer of On Regimen does – that in sleep the body is at rest but that the soul works. Sleep is for Aristotle an affection of the complex of soul and body due to the heating and cooling of food and preventing the animal from perceiving actual sense movements. It is obvious, therefore, that we cannot say that Aristotle is influenced here by the medical writer’s views on dreams. It would be more appropriate to say that the non-specialised student of nature gives a theoretical explanation or even a justification of the view held by the distinguished doctors; this justification is given entirely in Aristotle’s own terminology and based on his own presuppositions (the two principles mentioned above). This procedure is completely in accordance with his general views on the relation between natural science and medicine discussed above. However, the incorporation of the medical view on the prognostic value of dreams into his own theory of sleep and dreams does confront Aristotle with a difficulty which he does not seem to address very successfully. For, as we have seen above, in On Dreams Aristotle says that dreams are based on the remnants of small sensitive movements which we receive in the waking state but do not notice at the time, because they are overruled by more powerful movements which claim all our attention.

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Ethical issues in nursing home care: practice guidelines for difficult situations purchase diltiazem 180mg fast delivery. Heiman herein may be reproduced buy discount diltiazem 60mg line, transmitted cheap diltiazem 180 mg with amex, stored cheap 60 mg diltiazem, or used in any form or by Executive Editor: Jon-David Hague any means graphic discount diltiazem 180mg without a prescription, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, Assistant Editor: Rebecca Rosenberg information networks, or information storage and retrieval systems, except Editorial Assistant: Alicia McLaughlin as permitted under Section 107 or 108 of the 1976 United States Media Editor: Mary Noel Copyright Act, without the prior written permission of the publisher. Marketing Manager: Kim Russell For product information and technology assistance, contact us at Marketing Assistant: Anna Andersen Cengage Learning Customer & Sales Support, 1-800-354-9706 Marketing Communications Manager: For permission to use material from this text or product, Talia Wise submit all requests online at www. My problem with many textbooks is that they take too much of a statistics-for-statistics-sake approach. They produce students who can compute an answer on demand, but who do not understand why researchers would do so or what the answer reveals about data. Instead, I concentrate on showing stu- dents the eloquence of the logic of statistics. When we simplify the jargon and boil them down to concrete ideas, statistics have practical purposes and they really do make sense. I believe that giving students an understanding of this is the most important com- ponent of any introductory course. The premise of this book is that statistics make sense when presented within the con- text of behavioral research. Therefore, each procedure is introduced using a simple study with readily understandable goals. The focus is that research examines relation- ships and that statistics are for describing and inferring such relationships. Each discus- sion ends, however, by returning to an interpretation of the study in terms of behaviors. Although the early examples involve very simple questions taken from everyday life, in later chapters, as students develop their statistical thinking, the examples become more representative of real research. Too often books simply offer up a concept and let students and their instructor sort it out. My approach is that if it is important enough to mention, then it is important enough to fully explain. To this end, the narrative attempts to teach the material— clearly and patiently—the way a good teacher does. Further, I believe the best teachers are those who can remember what it was like when they were first learning a concept, before they spoke the technical language and could think in such terms. Therefore, I do not forget that, from the student’s perspective, everything about this course is new and often very strange and a little scary. However, this book does not pander to student weaknesses and fears regarding math- ematics. On the one hand, the book is geared toward students who are neither proficient in math nor interested in becoming so, and who rather grudgingly learn statistics. On the other hand, I expect that, ultimately, students will be capable of performing and understanding the basic statistical procedures found in modern research—as “junior” researchers. Therefore, the tone is always “At first this may appear difficult, but you can do it. The similarities among different xxii Preface to the Instructor xxiii procedures are stressed, showing that they answer similar questions. And, the most diffi- cult concepts are presented in small chunks that span different chapters, so that they are less overwhelming when fully revealed. At the same time, I have tried to keep the material readable and engaging so that students enjoy it as well as learn from it. I include humor, at times I talk directly to students, I point out potential mistakes, and I provide tips on how to get through the course. In addition, several recurring individuals give a little “plot” to the book, providing continuity among topics, and alerting students to particular pitfalls. Throughout, I have tried to dispel the notion that statistics are incomprehensible and boring, and to show that learning statistics can be fun and rewarding. First, a chapter must often refer to a concept from a previous chapter, neces- sarily assuming that students remember its discussion. Second although students know to compute a correlation in the correla- tion chapter or a t-test in the t-test chapter, they have difficulty when asked to select the appropriate procedure for a proposed study from the entire set of procedures discussed in the course. Therefore, these new questions (1) force students to revisit previous concepts to ensure their integration with the present chapter, and (2) pro- vide practice at selecting procedures for specific studies from among all procedures discussed to that point.

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