By L. Agenak. Massachusetts College of Pharmacy and Health Sciences. 2018.
Progress in selection and production in jarrah (Eucalyptus marginata) resistant to Phytophthora cinnamomi for use in rehabilitation plantings protonix 40mg on line gastritis diet for children. Spermless males elicit large-scale female responses to mating in the malaria mosquito Anopheles gambiae cheap 40mg protonix visa gastritis zdravljenje. Transgenic plants for phytoremediation: helping nature to clean up environmental pollution. Selection, screening and field testing of jarrah resistant to Phytophthora cinnamomi. Progress and prospects for the use of genetically modified mosquitoes to inhibit disease transmission. Whilst operating within this framework, habitat modification in wetlands can eliminate or reduce the risk of disease, by reducing the prevalence of disease-causing agents, vectors and/or hosts and their contact with one another, through the manipulation of wetland hydrology, vegetation and topography. Modifications to habitat features can help reduce the capacity of the local habitat to maintain populations of disease-carrying vectors through reducing vector breeding sites and encouraging vector predators [►Section 3. Such measures are often preferable to more environmentally damaging biological and chemical control methods. Habitat modification can also reduce the likelihood of exposure of disease-causing agents such as species of bacteria and toxic algae and other contaminants although this technique is more often directed at hosts and disease vectors than at the causative agents. Measures can alter or reduce host distribution and density and may be used to disperse and encourage hosts away from outbreak areas. Maintaining ‘healthy’ naturally functioning wetlands is generally important for reducing the risk of disease. Damaged or degraded wetlands can result in poor water quality, reduced water flows and vegetation growth, features which provide ideal habitat for some disease-carrying vectors and may act as stressors for hosts. However, some characteristics associated with naturally functioning wetlands, such as good water quality and flow, may also directly encourage vector and host populations. It is therefore important to assess both the potential risks and benefits of wetland modification in reducing the risk of disease in light of the specific habitat requirements of the pathogen, vector and host. For invertebrate disease vectors and hosts, for example, measures will often depend on the specific environmental requirements of the aquatic life stage of the species. Effective management of wetland habitats requires a thorough understanding of wetland ecosystem functions of the inter-connected hydrological, geomorphological, biochemical and ecological components, as changing one parameter can have implications for another. Important processes include flow regimes, water level changes and flood inundation, and their effects on vegetation and sediment and the requirements of wetland fauna. The effects of habitat changes on predator populations should always be considered when determining habitat modification measures. As long as undertaken in the context of the wetland management plan, the following alterations to wetland hydrology and vegetation (often through changes to topography) can be used to reduce the risk of disease spread in wetlands. Altering wetland hydrology Altering the extent of inundated and saturated areas Wetland systems can be modified to alter the extent of an inundated and saturated area and hence available habitat for disease agents, vectors and hosts. A reduction in the extent of an inundated and saturated area will lead to a decrease in the abundance of some vectors and hosts (e. However, this is accompanied by an inevitable loss of valuable wetland services and therefore any adverse impacts on wetland ecosystem function should be carefully examined before such actions are taken. Changes in habitat characteristics may benefit one host population, whilst disadvantaging another. For example, certain obligate freshwater snail hosts may decrease in number after the reduction of an inundated and saturated area, whilst some mosquito species favour smaller isolated pools, created after infilling or draining. Altering water flow patterns Altering the water flow may change the retention time of water within the wetland and affect several key characteristics such as water quality, retention of flood-flows and vegetation, in turn affecting the habitat’s suitability for hosts and vectors. Alteration of water depth, for example, may change the extent of emergent macrophyte beds, manipulation of which can be used to minimise certain vector and host species. Reduced water depth and flow rates may cause decreased turbidity, and increased water temperatures in warmer weather, but can decrease temperatures in colder weather, influencing the distribution of some aquatic vector and host species, such as snails. Measures to alter water flow include changing the dimensions, gradient and features of water channels. Altering water quality Water quality may affect disease agents, hosts and vectors, primarily through changes to vegetation and water flows [►sections above and below]. Activities that generate high inputs of organic matter and pollutants to a wetland, such as intensive farming and industry, can be reduced to improve water quality, and piped inflows from potentially polluted sources can be routed away from the wetland system.
The the average life expectancy seems based interventions favour the rich greed is for ever-greater longevity buy protonix 20mg low price gastritis lasting weeks; the particularly hard to justify generic protonix 20mg with amex symptoms of gastritis and duodenitis. For this reason, tragedy is that the greed inﬂates the been described as a “fundamental population approaches to tackling the fear and poisons the present in the cause” of disease, which works fundamental causes of socioeconomic name of a better, or at least a longer, through a multiplicity of risk factors deprivation must remain the most future. Ultimately, the only way of and pathophysiological pathways effective way of tackling health combating disease mongering is to to produce multiple disease states inequalities . Even if one of these pathways a continuing role for individually based the timing of our dying. Barnard D (1988) Love and death: Existential dimensions of physicians’ difﬁculties with disease will reappear in a different not to be exacerbated. Abbasi K, Smith R (2003) No more free intervention is situated, the less likely disease, less remediable than poverty lunches. J, Koskela K (1982) Theory and action for guidelines on cardiovascular disease prevention 12. Freemantle N, Hill S (2002) Medicalisation, best strategy for reducing deaths from heart 14. Schwartz☯ so normal experiences get labeled The Case of Restless Legs as pathologic, and by expanding the Syndrome deﬁnition of disease to include earlier, To get a sense of how the media works milder, and presymptomatic forms in the context of a major disease (e. Discussions about disease In 2003, GlaxoSmithKline launched a mongering usually focus on the role of campaign to promote awareness about pharmaceutical companies—how they restless legs syndrome, beginning with “[Restless legs syndrome] is quite a serious sleep promote disease and their products press releases about presentations at disorder that affects a lot of people Their sleep is through “disease awareness” campaigns the American Academy of Neurology disturbed and, unless they are really awake, they and direct-to-consumer drug will not be aware of it” . Sometimes you previously approved for Parkinson promoted in another way: through feel sad or distracted or anxious. Does it mean you release entitled “New survey reveals approach stories about new diseases need medication? For some people, disorder—restless legs syndrome—is mongering by the pharmaceutical symptoms are severe enough to be keeping Americans awake at night” industry, pharmaceutical consultants, disabling. But for many others with and advocacy groups, journalists, too, milder problems, these “symptoms” may end up selling sickness. The side effects that overwhelm any • An urge to move the legs due to an authors have declared that no competing interests exist. Typically, the disease is vague, • Symptoms that occur primarily at night public domain, this work may be freely reproduced, with nonspeciﬁc symptoms spanning distributed, transmitted, modiﬁed, built upon, or a broad spectrum of severity—from and that can interfere with sleep or otherwise used by anyone for any lawful purpose. Schwartz are at the Veterans Affairs Outcomes Group, White River treatment gets enlarged in two ways: can range from less than once a month Junction, Vermont, United States of America, and the by narrowing the deﬁnition of health to many times a day. Recommended Center for the Evaluative Clinical Sciences, Dartmouth treatments include stretching exercises Medical School, Hanover, New Hampshire, United States of America. Key Elements of Disease Mongering and How the Media Could Do Better Key Elements of Disease Mongering When the Media Can Get Co-opted Suggestions for Doing Better Exaggerate the prevalence of disease Create a broad disease deﬁnition based on Uncritically accepts disease deﬁnition. Learn exact deﬁnition of disease and question whether it is appropriately vague and prevalent symptoms. Determine whether the prevalence estimate is credible: Are the “gold standard” diagnostic criteria being used as designed? Blur the distinction between mild and severe Highlights the important physical, social, and Be clear about the spectrum of disease. Encourage more diagnosis Highlight that doctors fail to recognize Quotes an “expert” about how doctors miss the Acknowledge the problems of overdiagnosis (e. Suggest that all disease should be treated Exaggerate the beneﬁts of the drug for Overstates the beneﬁt by providing only Objectively report beneﬁt by quantifying how well the drug works (e. Overstates the beneﬁt by quoting a strong claim Learn and state industry ties of researchers who make strong claims of beneﬁt from researchers with strong industry about a drug’s beneﬁt. Imply that there is no downside to Minimizes the harms by not mentioning the Quantify side effects (e. Imply that long- term treatment is safe and Ignores concerns about duration of clinical trials Caution readers that although treatment is generally long term, the effective.
The similarities of multiple diseases could be discerned either from relationships among the networks of individual parameters (e buy cheap protonix 40 mg on-line gastritis diet india. A highly interconnected Knowledge Network would link multiple individual networks of parameters in a flexible way generic protonix 40 mg mastercard gastritis food to eat. A user could chose to interrogate only a small part of the network by limiting his or her analysis to a single information layer, or even a small portion of this layer; alternatively, a user could interrogate the complex interrelationship of multiple parameters. High flexibility ensures easy cross-comparison and cross-correlation of any desired dataset, making it a versatile tool for a wide spectrum of applications ranging from basic research to clinical studies and healthy system administration. Widely accessible The Knowledge Network would need to be accessible and usable by a wide range of stakeholders from basic scientists to clinicians, health- care workers and the public. Furthermore, the available information would need to be mineable in ways that are custom-tailored to the needs of different users, possibly by implementation of purpose-specific user interfaces. While the Committee agreed upon the generalities listed above and illustrated in Figure 3-1, about the Information Commons and Knowledge Network —and their relationship to a New Taxonomy— specifics of implementation such as the detailed design of the Information Commons, the information technology platforms used to create it, questions about where key infrastructure should be physically housed, who would oversee it, and how the Information Commons would be financed, were considered beyond the scope of the Committee’s charge in a framework study. Nonetheless, dramatic developments in the fields of medical information technology—and other developments discussed in Chapter 2—give the Committee confidence that the creation and implementation of this ambitious and novel infrastructure is a feasible goal. The Proposed Knowledge Network Would Fundamentally Differ from Current Biomedical Information Systems Immense progress has been made during the past 25 years in organizing our knowledge of basic biology, health, and disease, even as many components of this knowledge base have grown super-exponentially. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 46 The key difference is that the information commons, which would underlie the other databases, would be “individual-centric. An independent researcher, who was not involved in the study that contributed these entries, has no way of knowing that they are from the same individual. As a consequence, relationships between multiple parameters that determine disease status in a given individual are impossible to extract. This information was not collected in a way that allows the individual to be the central organizing principle, and no amount of redesign of the inter-connections between different entries in the current system could achieve the goals the Committee has outlined. The Committee would like to emphasize the novelty and power of an Information Commons that is “individual-centric. For example, given the coordinates of a large number of, say, backyard barbecue grills, one can suddenly overlay a vast amount of socio-economic, ethnic, climatological, and other data on what—at the start of the investigation—appeared a peculiar, anecdotal inquiry. Despite significant challenges to constructing an individual-centric Information Commons, the Committee concluded that this is a realistic undertaking and would be essential to the success of the Knowledge-Network/ New Taxonomy initiative. The Committee is of the opinion that “precision medicine,” designed to provide the best accessible care for each individual, is not achievable without a massive reorientation of the information systems on which researchers and health-care providers depend: these systems, like the medicine they aspire to support, must be individualized. Generalizations must be built up from information on large numbers of individuals. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 47 is lost when molecular profiles, data on other aspects of an individual’s circumstances, and health histories are abstracted away from the individual at the very beginning of investigations into the determinants of health and disease. A Knowledge Network of Disease Would Continuously Evolve Although knowledge of disease, and particularly molecular mechanisms of pathogenesis, is still limited, the pace of progress has never been greater. New insights into the biology of disease are emerging rapidly from a wealth of molecular approaches, as well as from new insights into the importance of environmental factors. However, the system for updating current disease taxonomies, at intervals of many years does not permit the rapid incorporation of new information, thereby contributing to the delayed introduction of advances that have the potential, over time, to guide mainstream practice. The individual-centric nature of an Information Commons is an important means of ensuring that the data underlying the Knowledge Network, and its derived taxonomy, would be constantly updated. Such a dynamic system would not only accept new inputs for established disease parameters, it would also accommodate new types of information generated by newly developed technologies, to identify, acquire, measure, and analyze new biological features of disease. The New Taxonomy Would Require Continuous Validation Bad information is worse than no information. A key feature of a clinically useful taxonomy is the requirement for a validation system. The logic of the classification scheme, and especially its utility for practical applications, needs to be carefully and continuously tested. This is particularly important when patients and clinicians use the New Taxonomy to inform clinical decisions. The New Taxonomy should be routinely tested to provide all stakeholders with data indicating the extent to which decisions guided by it can be made with confidence.
In this case generic protonix 20 mg with mastercard gastritis diet xenadrine, we are looking at the likelihoods of having a negative test in people with and without the disease protonix 40mg line gastritis peptic ulcers symptoms. Their values are determined by clinical studies against a gold standard, therefore, published reports of likelihood ratios are only as good as the gold standard against which they are based and the quality of the study that determined their value. In gen- eral, one would like the likelihood ratio of a positive test to be very high, ideally greater than 10, to maximally increase the probability of disease after doing the test and getting a positive result. Similarly, one would want the likelihood ratio of a negative test to be very low, ideally less than 0. This tells the reader how sensitive the test is for ﬁnding those persons with disease when only looking at those with disease. It displays how often the result is a true positive compared to a false negative as it is the fraction of people with the disease who test positive. It is important to note that sensitivity can only be calculated from among people who have the disease. Probabilistically, it is expressed as P[T+|D+], the probability of a positive test if the person has disease. This is because in a very sensitive test, there are very few false negatives, therefore virtually all neg- ative tests must occur in non-diseased people. In addition, if the clinician has properly reduced the number of diagnostic possibilities, it would be even more unlikely that the patient has the disease in question. As a general rule, when two or more tests are available, the most sensitive one should be done to min- imize the number of false negatives. A sensitive test rules out disease – and the mnemonic is SnOut (Sensitive = ruled Out). It tells the reader how speciﬁc the test is for ﬁnding those persons without disease, when only looking at those without disease. It demonstrates how often the result is a true negative compared to a false positive, as it is the fraction of people without the disease who test negative. It is important to realize that speciﬁcity can only be calculated from among people who do not have the disease. Probabilistically, it is expressed as P[T−|D−], the probability of a negative test if the person does not have disease. This is because there are very few false positives, therefore any positive tests must occur in diseased people. If the clinician has properly reduced the number of diagnostic possibilities, then it would be even more likely that the patient does have the disease in question. When two or more tests are available, the most speciﬁc should be done to min- imize the number of false positives. This is especially true for diseases that are Utility and characteristics of diagnostic tests 257 Table 23. An exam- ple of a very speciﬁc test is the ultrasound for deep venous thrombosis of the leg. If the ultrasound is positive, it is extremely likely that there is a clot in the vein. A speciﬁc test rules in disease – and the mnemonic is SpIn (Speciﬁcity = ruled In). It tells the reader how often the result is a false negative compared to a true positive. Using sensitivity and speciﬁcity The sensitivity and speciﬁcity are the mathematical components of the like- lihood ratios. They are the characteristics that are most often measured and reported in studies of diagnostic tests in the medical literature. Three mnemon- ics can help to remember the difference between sensitivity and speciﬁcity. Like likelihood ratios, true positive rate, false posi- tive rate, true negative rate, and false negative rate are also intrinsic characteris- tics of a diagnostic test. We have previously noted the mathematical relationship between sensitivity and speciﬁcity and the likelihood ratios.