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Early identifcation of patients at increased risk of acute kidney injury can prevent deterioration in renal function. Chronic kidney disease is the major risk factor for acute kidney injury Acute kidney injury is a medical emergency characterised by Acute kidney injury is now the preferred a rapid (hours to days) fall in glomerular fltration rate. When this is combined with polypharmacy, including nephrotoxic medicines, the likelihood of an acute-on-chronic decline in renal function is increased. Patients Acute glomerulonephritis, particularly as a result of small with intrinsic renal disease or low grade chronic obstruction vessel vasculitis, is an uncommon but important cause of may be largely asymptomatic. The causes of acute kidney injury can be divided into three categories: Post-renal injury 1. This is obstructive nephropathy and is a relatively uncommon cause of acute kidney injury (5%). The defning feature of acute pre-renal injury is that if retroperitoneal fbrosis or prostatic and other pelvic normal blood fow can be re-established, renal function will malignancy often rapidly recover. This results in the serum creatinine fuctuating in the absence of clear precipitants. Previous creatinine measurements are the most useful tool for confrming and assessing the severity of acute kidney injury. They should also be advised to avoid taking nephrotoxic medicines, Patients who have a single raised serum creatinine and no including over-the-counter medicines. In the absence of another creatinine result every efort should be made to fnd a past Diagnostic procedures may increase the risk of acute result. Metformin is contraindicated 10 A clinical history may suggest an obvious cause in procedures involving iodine-containing contrast media. Colonoscopy requires bowel preparation which can increase the fndings of the clinical history and physical examination the risk of diarrhoea and volume depletion. A history of abdominal or pelvic malignancy causing Red fags requiring urgent hospital admission include:7 obstruction or myeloma causing intrinsic injury from Negligible urine output for 6 hours or < 200 mL over 12 heavy proteinuria hours Systemic symptoms, such as a rash, joint or muscle pain Serum potassium > 7. Treat urinary obstructions Where a clinical history and physical examination suggest 3. Review medicine use acute renal injury a urine dipstick test should be performed in order not to miss a renal infammatory process. Restoration of renal perfusion is the goal in the treatment of pre-renal causes of acute kidney injury. Urgent referral to secondary care is recommended for patients with serum potassium > 7. Shared 4 decision-making Personalize goals to achieve glycemic control with a hemoglobin A1c in the range of < 7 or 8% based on the risks and benets for each patient Shared decision-making with a full Shared discussion of the risks and benets of decision-making treatment and consideration of patient values 5 and preferences. A recommendation has been made and shouldbe utilized; the benet outweighs the harms for most patients. A recommendation has been made andmay be utilized; the benet is felt to potentially outweigh the harms for most patients. A recommendation against has been made; the harms outweigh the benets for most patients. Literature search terms used for this revision are below and include literature from January 1, 2004, through May 31, 2014. Hand searching of identifed articles and work group submission was also undertaken. Lifestyle changes such as nutrition therapy, weight loss, increased exercise, and appropriate education and self-management strategies are pivotal to improved outcomes. In the current iteration of this guideline, we have focused on the importance of appropriate identifcation and diagnosis, followed by effective approaches to lifestyle management and pharmacologic therapy. Management recommendations will include nutrition therapy, physical activity, self management approaches and pharmacologic therapy, as well as the prevention and diagnosis of diabetes associated complications and risk factors. Oral agents do not have Food and Drug Administration approval for use in pregnancy. Additionally, the glycemia goals used are different in pregnancy and require more aggressive treatment. The diagnosis and management of type 1 diabetes is not included in this guideline. Both individual measures of diabetes care, as well as comprehensive measures of performance on broader sets of measures, are recommended. Therefore, the aims and measures listed here are selected carefully in the interests of patient safety. Systolic blood pressure level should be the major factor for detection, evaluation and treatment of hypertension. The use of two or more blood pressure-lowering agents is often required to meet blood pressure goal. However, a number of key processes have been shown to accelerate effective clinical guideline imple mentation and care improvement (Sperl-Hillen, 2005). Medical group leaders must communicate the need for change in clinical practice patterns and consistently identify improvement priorities. Resources adequate to the task at hand will be needed to assure the success of a change effort. Resources may include staff time, money and provision of tools (such as elec tronic medical records) to support care improvement. For most chronic diseases, including diabetes, the most effcient improvement strategy is to focus on a limited number of specifc improvement goals. Accountability within the medical group is a management responsibility, but external accountability may also play an important enhancing role to motivate sustained efforts to implement guidelines and improve care. Examples of external accountability include participa tion in shared learning activities or public reporting of results (such as in pay-for-performance or the Minnesota Community Measures Project). The medical group may need to foster the development of prepared practice teams that are designed to meet the many challenges of delivering high-quality chronic disease care. These are registries that are designed to identify, auto matically monitor, and prioritize patients with diabetes based on their risk, current level of control, and possibly patient readiness-to-change. Previsit planning and best practice prompts may help to increase the effciency of patient visits and remind clinicians of needed tests and care. Outreach strategies that enhance the likeliness of a future provider encounter that addresses one of the barriers to patient activation (discussed below) may be more effective. Simple reporting of lab test results or care suggestions through the mail may be ineffective at addressing these barriers. These may include diabetes education and other actions designed to sustain engagement of patients with his/her diabetes care. Many patients with diabetes either (a) do not really believe they have diabetes, or (b) do not really believe that diabetes is a serious disease, or (c) lack motivation for behavioral change, or (d) do not believe that recommended treatments will make a difference to their own outcomes. Targeted testing for patients of any age who are overweight or obese and have additional risk factors has shown to be cost effective. Benefits-Harms Assessment: Diabetes screening is potentially costly and has not been proven to result in improved patient outcomes. However, the condition is common, serious, and a cause of serious microvascular and macrovascular health complications. Selective testing of high-risk individuals can reduce the costs compared to universal testing. Relevant Resources: Casagrande, 2013; Colosia, 2013; Waugh, 2013; Ackermann, 2011; Li, 2008; Gregg, 2004 Return to Algorithm Return to Table of Contents 1. Some patients may have increased testing and treatment without benefit, and having the diagnosis of diabetes could potentially have negative psychosocial and economic ramifications for individuals. Relevant Resources: Casagrande, 2013; Colosia, 2013; Waugh, 2013; Rahman, 2012; Ackermann, 2011; American Diabetes Association, 2010; Li, 2008; U. Preventive Services Task Force, 2008 Return to Algorithm Return to Table of Contents

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Premature infants (poor absorption and ^ requirement of zinc) when weaned off breast milk (which has adequate zinc level) 2. The Hospital Juvenile Hyaline Fibromatosis for Sick Children: Atlas of Pediatrics. Vascular malformations represent errors in vas cular morphogenesis (dysplastic vessels) without true cellular proliferation and without regression. Vascular Tumors Vascular Malformations Infantile and Congenital Capillary Malformation (slow ow): Hemangiomas Port-Wine Stain (Nevus Flammeus) Kaposiform Venous Malformation (slow ow): Hemangioendothelioma Cavernous Hemangioma, Phlebectasia Pyogenic Granuloma Lymphatic Malformation (slow ow): Lymphangioma (Lymphangioma Circumscriptum Cystic Hygroma, Cavernous Lymphangioma) Tufted Angioma Arteriovenous Malformation (fast ow): Cirsoid Aneursm Congenital Combined Malformation (slow or fast ow) Hemangiopericytoma A. Paul Getz) B: Anhidrotic ectodermal dysplasia D: Palmoplantar keratoderma in Vohwinkel syndrome (Courtesy of Dr. Incontinentia pigmenti: a review and update on the molecular basis of pathophysiology. Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. Netherton syndrome: a syndrome of elevated IgE and characteristic skin and hair ndings. Subcutaneous fat necrosis of the newborn: a case report and review of the literature. To be a peak performer you need to be fully By the end of this course, you will have a alert, dynamic, energetic, in a good mood, better understanding of and cognitively sharp. We must learn interest in, and your thoughts about, these are what you should know or be 5 to value sleep, yet most of us know very sleep and dreams. I also hope that it will able to do by the end of this course little about the incredibly varied activity increase your appreciation for the im that occurs during the course of each night, portance of sleep and the potential con F. If you are going to be late or miss class, turn the assignment in early or have someone Check here first. Plagiarism or other forms of academic dis the Jawbone activity tracker Participation honesty will result in full disciplinary action as outlined in the Nichols Academic Honesty Policy I want you to succeed my course. Furthermore, documen class with questions, insights and be prepared to tation of the incident will be placed on file with discuss the relevance and application of course the Vice President for Academic Affairs. Use of technology I have found that students who do well in my class Please use any technology that helps you learn, Read the assigned material before class. The app displays your data, lets you add How to submit the online assign things like meals and mood, and delivers Attendance ments insights that keep you moving forward. Attendance is especially important in a course First go to the course website (see page 1). If you miss more than 4 read them and complete the questions on the classes, you must schedule an individual meeting form. Changes to this syllabus A religious holiday Each class will begin with an outline that you can A Nichols Sponsored event with prior noti this syllabus may change if needed. Class changes to our schedule, syllabus or poli sessions will consist of a balance of factual Extended medical absences cies quickly and efficiently through the knowledge, conceptual knowledge and the ap course website and via email. Then we result in cumulative or consecutive student ab My teaching perspective: will break into our dream teams and discuss the sences of three weeks or longer during a semester. When thinking of my students, I wonder if most recent dream blogs (see For example, extended absences can include, but they will answer the question "Were you nicholsdreams. Students who require an extended absence must complete a Request for Special Foundation radical change Davis Page 2 Reflection papers: Assignments & grading (6 @ 22 points each, 132 points=13% see course website): *Note your lowest Guidelines and advice for making the score is dropped. Please read them and answer the questions presented in the Your grade is based on the number of online forms for each article or video. Death by sleep Survey Baseline After completing the baseline test measures walker. You will score your four tests and Presenta write an analysis of your current sleeping pat Sleep analysis paper: (130 pts. The exact format ditional multiple choice and matching) and Ex 15% and grading rubric is in this syllabus. There is 12% Campus Sleep Awareness team no final exam; rather your final draft is the sleep project presentations: (100 points) analysis paper. Teams will design conduct and present the outcome of their National Sleep Awareness Sleep Journals: Week projects. Good terns, please complete these sleep logs they are Grading scale: due every seven days. These are from the Na projects will accomplish some of the follow Your grade is based on the percentage ing goals tional Sleep Foundation and will be returned to of points earned during this course. Due every Tuesday A = 1000-930 | A-= 929-900 | portance of adequate sleep to health and B+ = 899-878 | B = 877-830 | safety. Website 13 Snow day Examination I: Dream theories, explanations & psychoa Sleep journal (Week 3) Dream 18 nalysis. Davis Page 4 25 Part V: Sleep disorders: Effects of sleep deprivation; Chapter 13: Insomnia & Beyond. Due by 1:30 on 4/17/14 17 (Format: Take home online) Available online from 4/15/14-4/17/14 22 Sleep Awareness Week Collect data and prepare for presentations st 24 1 draft of Sleep & Dream analysis pa Sleep Awareness Week Collect data and prepare for presentations pers due by 1:30. If there is an abbreviated schedule on a bad weather day, all classes meet for a 50-minute class period. Examples of accommodations which have customarily been requested and permitted may include exam What if I need learning accommodations & support services Students with documented learning differences and/or physical limitations, who are in need of accommodations, should contact the Assistant Dean for Learning Services at 508-213-2293. You must demonstrate What is the course policy re academic integrity in taking the exams. Each student should complete the online assignments indi vidually; not in groups. Plagiarized work or exam cheating is an automatic zero on the assignment & garding plagiarism and aca may cause you to fail the course. I take such violations very seriously, so please familiarize yourself demic honesty

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Cross Reference Pes cavus Claw Hand Claw hand, or mainengriffe, is an abnormal posture of the hand with hyperex tension at the metacarpophalangeal joints (fth, fourth, and, to a lesser extent, third nger) and exion at the interphalangeal joints. Cross References Benediction hand; Camptodactyly Clonus Clonus is rhythmic, involuntary, repetitive, muscular contraction and relaxation. It may be induced by sudden passive stretching of a muscle or tendon, most usu ally the Achilles tendon (ankle clonus) or patella (patellar clonus). Ankle clonus is best elicited by holding the relaxed leg underneath the moderately exed knee, then quickly dorsiexing the ankle and holding it dorsiexed. A few beats of clonus are within normal limits but sustained clonus is pathological. Clonus reects hyperactivity of muscle stretch reexes and may result from self-re-excitation. It is a feature of upper motor neurone disorders affecting the corticospinal (pyramidal) system. Patients with disease of the corticospinal tracts may describe clonus as a rhythmic jerking of the foot, for example, when using the foot pedals of a car. Cluster Breathing Damage at the pontomedullary junction may result in a breathing pattern char acterized by a cluster of breaths following one another in an irregular sequence. Cross Reference Coma Coactivation Sign this sign is said to be characteristic of psychogenic tremors, namely, increased tremor amplitude with loading (cf. These phenomena are said to be characteristic signs of ocular myasthenia gravis and were found in 60% of myasthenics in one study. They may also occur occasionally in other oculomotor brainstem disorders such as Miller Fisher syndrome, but are not seen in normals. Myasthenia gravis: a review of the disease and a description of lid twitch as a characteristic sign. Such collapsing weakness has also been recorded following acute brain lesions such as stroke. There may be accompanying paralysis of vertical gaze (especially upgaze) and light-near pupillary dissociation. The sign is thought to reect damage to the posterior commissure levator inhibitory bres. Nuclear ophthalmoplegia with special reference to retraction of the lids and ptosis and to lesions of the posterior commissure. It represents a greater degree of impairment of consciousness than stupor or obtundation, all three forming part of a continuum, rather than discrete stages, ranging from alert to comatose. Assessment of the depth of coma may be made by observing changes in eye move ments and response to central noxious stimuli: roving eye movements are lost before oculocephalic responses; caloric responses are last to go. A number of neurobehavioural states may be mistaken for coma, including abulia, akinetic mutism, catatonia, and the locked-in syndrome. Cross References Abulia; Akinetic mutism; Caloric testing; Catatonia; Decerebrate rigid ity; Decorticate rigidity; Locked-in syndrome; Obtundation; Oculocephalic response; Roving eye movements; Stupor; Vegetative states; Vestibulo-ocular reexes Compulsive Grasping Hand this name has been given to involuntary left-hand grasping related to all right-hand movements in a patient with a callosal haemorrhage. This has been interpreted as a motor grasp response to contralateral hand movements and a variant of anarchic or alien hand. The description does seem to differ from that of behaviours labelled as forced groping and the alien grasp reex. Reading comprehension is good or normal and is better than reading aloud which is impaired by paraphasic errors. Conduction aphasia was traditionally explained as due to a disconnection between sensory (Wernicke) and motor (Broca) areas for language, involving the arcuate fasciculus in the supramarginal gyrus. Certainly the brain damage (usu ally infarction) associated with conduction aphasia most commonly involves the left parietal lobe (lower postcentral and supramarginal gyri) and the insula, but it is variable, and the cortical injury may be responsible for the clinical picture. This phenomenon sug gests that an acoustic image of the target word is preserved in this condition. A similar phenomenon may be observed in patients with optic aphasia attempting to name a visual stimulus. A similar behaviour is seen in so-called speech apraxia, in which patients repeatedly approximate to the desired output before reaching it. The term may also be used to refer to a parapraxis in which patients attempt to perform a movement several times before achieving the correct movement. Cross References Aphasia; Conduction aphasia; Optic aphasia; Parapraxia, Parapraxis; Speech apraxia 90 Congenital Nystagmus C Confabulation the old denition of confabulation as the falsication of episodic mem ory occurring in clear consciousness, often in association with amnesia (in other words, paramnesias related as true events), has proven increasingly de cient, not least because most amnesic patients, suffering from medial temporal lobe/hippocampal lesions, do not confabulate, and poor memory alone cannot explain confabulation. Schnider has developed a fourfold schema of intrusions, momentary confabulations, fantastic confabulations, and behaviourally sponta neous confabulations, of which the latter are clinically the most challenging. Anterior limbic structures are thought culpable, and the pathogenesis includes a wide variety of diseases, which may include associated phenomena such as amnesia, disorientation, false recognition syndromes including the Capgras delu sion, and anosognosia. Moreover, as there is a lack of corre lation of meaning when this term is used by different health professionals, it is regarded by some as an unhelpful term. This may be due to a variety of factors, including prolonged muscle spasticity with or without muscle brosis. This often occurs in the context of limb immobilization or inactivity, for example, in a exed posture. Injections of botulinum toxin to abolish muscle spasticity may be required to assess whether there is concurrent ligamentous restriction, and thus to plan opti mum treatment, which may involve surgery.

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When a player finnishes the puuzzle he is giiven some baasic informattion about thhe artefact. There is also a typingg game whicch is based on the Archival Dictionaary where the playeer has to type quickly Ennglish wordss and phrasees that are uused in ar chival praactice. Thhis game is designed forr archivists wwho want too learn archiival termi nology annd have fun wwhile first twwo games aree designed foor anyone intterested in archives and are locaated in the ssection for aarchival pedaagogy. Howeever, there arre plans to eexpand ar 10 chival gammes based onn the world mmap of archiives which is also on thhis site and which haas enough coontent to creeate quizzes, crossword puzzles, woord search games, annd other puzzzle games. When creating a game that is similar to an already well-known game, the game developer should first check if there is an existing template or code which can be reused free of cost. All of the games presented in this paper were made using free technology accessible through the Internet. Memory, crossword puzzles, Word Search games, Tic-tac-toe, that do not require keyboard controllers can be played on mobile devices. Many games, such as Croatian spelling quizzes, were made with a quiz game type which allows the creation of multiple type questions. Quiz creators can decide on the number of points for each question and the feedback messages for certain answers. There is also a hint button which can be enabled and options for customizing text messages in buttons and results so quizzes can be made for multiple languages. The solutions and points can be shown immediately after the answer is given or after the whole quiz is com pleted. There is also a memory game in which some text information is dis played when a pair is matched. This is used for explaining objects in images such as archives in the memory with Croatian archives which was made for the website of the Croatian Archival Society. There is also a flashcard quiz in which an image is displayed and the player must type what he sees on the pic ture, interactive video where a question is displayed at a certain point in the video, timeline tool for telling stories in a chronological order, image hotspot for marking parts of the image and adding dialog boxes to them which open when the user clicks on a marked part of the image. The code for certain games such as Tic-tac-toe was modified so that questions appear each time a player makes a move. If a player answers a question correctly, he is allowed to place his mark on the table, if his answer is wrong, he loses a turn. Mihaljevic, Creation and use of game-based learning material Search were modified so that they show Glagolitic fonts and use Croatian words for their learning corpus. They were also graphically modified in the style of the Middle Ages, when Glagolitic letters were used. Unfortunately, Construct 2 free version has certain restrictions because it allows publishing games that have only a certain number of events. Once the tool for creating games is selected and game mechanics programmed, there is a need to create the visual identity for the game by using available graphics and resources. They were mostly found on Pixabay site, which offers thousands of pho tos and cliparts free for use for any purpose. They especially have a wide range of clipart vector graphics which can be modified to look good on any screen resolutions. Drawings for the game A Day in a Life on the site of Language Games, where a player must drag sentences to a drawing that represents a typi cal working day was drawn by one of the high school students at a computer science class. The sound clips for Glagolitic memory and snake were created by 16 the musician Ivan Mihaljevic and sound clips for other games were down loaded from Freesound. The gamames were mostly ussed at the beginning or thhe end of a lesson as a wway to repeatt and prac tice the pprevious lessons. An onnline surveyy created witth KwikiSurrveys was given to each of the first and seccond-year stuudents aboutt the use of ggames for motivatinng them. Howeveer, 51% studdents admitted that they ddid not use the site foor repetition before the eexam. This mmeans that mmost of themm were not aware off the importaance of gammes for the eexam althouggh in the gaames there were somme questions that ended in the examm. Their favoorite game (554%) was Tic-tac-tooe with quesstions followwed by Memmory where they match computer parts (22%%). As this ssurvey did noot have a larrge number oof examineess, which is at the mooment imposssible becausse these gammes are onlyy used in thee first two years andd only in one school, it pooints to the cconclusion thhat most teennagers like when eduucational gammes are useed in class bbut are not aaware that bby playing them theyy can learn ffor the test inn an efficientt way. The rresults wouldd probably be even bbetter with eelementary sschool childdren since yoounger childdren enjoy games moore and Commputer Sciencce is not an obligatory suubject in Crooatian ele mentary sschools so mmostly only chhildren who like computeers and gamees enrol in these classses. Do youu like it when thhe teacher uses computer gamees for 53 (77%) 16 (23%) repeatinng lessons Do youu think that the games helped yyou with the leaarning 39 (63%) 23 (37%) processs Many students wrote Tetris, therefore the game Binary Tetris with questions from the field of computer science was created and it became one of the most popular games on this site. Tetris (7 answers) Hangman (4 answers) Pictionary (3 answers) Conclusion the idea of an interactive, highly engaging training and education is very old. While traditional edu cational methods such as reading, writing, and lecturing are still widely used, the gap between traditional methods and learning through modern interactive multimedia education technology is becoming narrower as technology is enter ing into more and more classrooms. Even the results of the pilot research show that there is an interest for game based learning among high-school students. How ever, there is still a growing need to design and develop specific games for learning many different subjects and do research on the influence of gamifica tion and game-based learning in specific classroom and learning situations. For that, a good collaboration between programmers, designers, and teachers has to be established or teachers have to learn how to design and create games for their subjects. Fortunately, technology is becoming more available and much easier to use so in a few years maybe many teachers will be able to create their own game-based learning resources. So in the future, the author hopes to expand his research to other high schools and/or elementary schools. Business simulations and cognitive learning: Developments, desires, and future directions. Mihaljevic, Creation and use of game-based learning material Croatian dictionary history timeline. Moodle Tip: How to award badges in Moodle based on different levels of performance. The basic idea is to help students or people interested in cryptography in their learning activities by providing them with an application capable of presenting basic information about codes and ciphers. Another goal is to give the users a chance to test out all of the ciphers contained within the application. One positive as pect of this kind of software is the fact that it can be adjusted to the user by us ing different languages and their alphabets in the learning process. Aside from personal use, this software can be incorporated in the classroom as an educa tional aid. Keywords: cryptography, ciphers, encryption, decryption, education, security, classroom aids Introduction In these modern times, we consider information as one of our most valuable re sources. Since we view information as an extremely valuable resource, the need for masking and hiding information from unwanted interceptors arose quite fast. Other key advances were made in terms of teaching and learning by developing different presentation techniques to accommodate different learning styles. The application is not intended only for students and focuses on anyone interested in learning about cryptography. Cryptography and its contemporary use Cryptography is a scientific discipline which focuses on studying and develop ing methods of sending messages in a concealed form, that is, in such a way that 2 they can be read only by the person for whom the message is intended. The two main methods of concealing messages in cryptography are codes and ciphers, 3 which are defined as: A cipher refers to an algorithm which replaces the order of letters or re places each letter with a symbol or a different letter based on a key. The algorithm consists of encryption and decryption steps (steps required to make a message readable or unreadable. A code always requires the use of a code book, as it serves as a reference in both the encryption and de cryption process. A code book is a lookup table consisting of words or phrases, and their corre 4 sponding code (there also may be multiple codes intended for one word or phrase. Security Engineering: A Guide to Building Dependable Distributed Systems, First edition. Reliance on this certain 5 technology also means that it is one of the key factors of online privacy.

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Patients should be advised to rest at the first sign of tendinitis or tendon rupture, and to contact their healthcare provider regarding changing to a non-quinolone antimicrobial drug. Some reactions have been accompanied by cardiovascular collapse, hypotension/shock, seizure, loss of consciousness, tingling, angioedema (including tongue, laryngeal, throat, or facial edema/swelling), airway obstruction (including bronchospasm, shortness of breath, and acute respiratory distress), dyspnea, urticaria, itching, and other serious skin reactions. Serious acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures, including oxygen, intravenous fluids, antihistamines, corticosteroids, pressor amines, and airway management, as clinically indicated [see Adverse Reactions (6); Patient Counseling Information (17. These events may be severe and generally occur following the administration of multiple doses. The drug should be discontinued immediately at the first appearance of skin rash, jaundice, or any other sign of hypersensitivity and supportive measures instituted [see Adverse Reactions (6); Patient Counseling Information (17. No evidence of serious drug-associated hepatotoxicity was detected in clinical trials of over 7, 000 patients. Severe hepatotoxicity generally occurred within 14 days of initiation of therapy and most cases occurred within 6 days. Most cases of severe hepatotoxicity were not associated with hypersensitivity [see Warnings and Precautions (5. The majority of fatal hepatotoxicity 15 reports occurred in patients 65 years of age or older and most were not associated with hypersensitivity. Fluoroquinolones may also cause increased intracranial pressure and central nervous system stimulation which may lead to tremors, restlessness, anxiety, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia, and, rarely, suicidal thoughts or acts. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. In immature rats and dogs, the oral and intravenous administration of levofloxacin resulted in increased osteochondrosis. Histopathological examination of the weight-bearing joints of immature dogs dosed with levofloxacin revealed persistent lesions of the cartilage. Other quinolones also produce similar erosions in the weight-bearing joints and other signs of arthropathy in immature animals of various species [see Animal Toxicology and/or Pharmacology (13. Drug therapy should be discontinued if photosensitivity/phototoxicity occurs [see Adverse Reactions (6. The population studied had a mean age of 50 years (approximately 74% of the population was < 65 years of age), 50% were male, 71% were Caucasian, 19% were Black. Treatment duration was usually 3-14 days, and the mean number of days on therapy was 10 days. The most common adverse drug reactions leading to discontinuation with the 250 and 500 mg doses were gastrointestinal (1. The most common adverse drug reactions leading to discontinuation with the 750 mg dose were gastrointestinal (1. The most common adverse drug reactions (3%) are nausea, headache, diarrhea, insomnia, constipation, and dizziness. Because these reactions are reported voluntarily from a population of uncertain size, reliably estimating their frequency or establishing a causal relationship to drug exposure is not always possible. Table 8: Postmarketing Reports Of Adverse Drug Reactions System/Organ Class Adverse Reaction Blood and Lymphatic System pancytopenia Disorders aplastic anemia leukopenia hemolytic anemia [see Warnings and Precautions (5. Tablets with antacids containing magnesium, aluminum, as well as sucralfate, metal cations such as iron, and multivitamins preparations with zinc or didanosine may substantially interfere with the gastrointestinal absorption of levofloxacin, resulting in systemic levels considerably lower than desired. However, no fluoroquinolone should be co-administered with any solution containing multivalent cations. Similarly, no apparent effect of warfarin on levofloxacin absorption and disposition was observed. Patients should also be monitored for evidence of bleeding [see Adverse Reactions (6. Therefore, careful monitoring of blood glucose is recommended when these agents are co-administered [see Warnings and Precautions (5. Similarly, no apparent effect of theophylline on levofloxacin absorption and disposition was observed. However, concomitant administration of other fluoroquinolones with theophylline has resulted in prolonged elimination half-life, elevated serum theophylline levels, and a subsequent increase in the risk of theophylline-related adverse reactions in the patient population. Adverse reactions, including seizures, may occur with or without an elevation in serum theophylline levels [see Warnings and Precautions (5. However, elevated serum levels of cyclosporine have been reported in the patient population when co-administered with some other fluoroquinolones. Levofloxacin Cmax and ke were slightly lower while Tmax and t were slightly longer in the presence of cyclosporine than those observed in other studies without concomitant medication. Levofloxacin absorption and disposition kinetics were similar in the presence or 25 absence of digoxin. Confirmation of positive opiate screens by more specific methods may be necessary. Levofloxacin was not teratogenic in rats at oral doses as high as 810 mg/kg/day which corresponds to 9. The oral dose of 810 mg/kg/day to rats caused decreased fetal body weight and increased fetal mortality. No teratogenicity was observed when rabbits were dosed orally as high as 50 mg/kg/day which corresponds to 1. Inhalational Anthrax (Post-Exposure) Levofloxacin is indicated in pediatric patients for inhalational anthrax (post-exposure). The risk-benefit assessment indicates that administration of levofloxacin to pediatric patients is appropriate. The safety of levofloxacin in pediatric patients treated for more than 14 days has not been studied. The pharmacokinetics of levofloxacin following a single intravenous dose were investigated in pediatric patients ranging in age from six months to 16 years. Pediatric patients cleared levofloxacin faster than adult patients resulting in lower plasma exposures than adults for a given mg/kg dose [see Indications and Usage (1. However, the incidence of musculoskeletal disorders were calculated using all reported events during the specified period for all children enrolled regardless of whether they completed the 1-year evaluation visit. Most of the musculoskeletal disorders in both groups involved multiple weight bearing joints. No child had a severe or serious disorder and all musculoskeletal disorders resolved without sequelae. In addition to the events reported in pediatric patients in clinical trials, events reported in adults during clinical trials or post-marketing experience [see Adverse Reactions (6)] may also be expected to occur in pediatric patients. This risk is further increased in patients receiving concomitant corticosteroid therapy. Tendinitis or tendon rupture can involve the Achilles, hand, shoulder, or other tendon sites and can occur during or after completion of therapy; cases occurring up to several months after fluoroquinolone treatment have been reported. Of these, 1, 081 patients (14%) were between the ages of 65 and 74 and 864 patients (12%) were 75 years or older. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, but greater sensitivity of some older individuals cannot be ruled out. The majority of fatal hepatotoxicity reports occurred in patients 65 years of age or older and most were not associated with hypersensitivity. The pharmacokinetic properties of levofloxacin in younger adults and elderly adults do not differ significantly when creatinine clearance is taken into consideration. However, since the drug is known to be substantially excreted by the kidney, the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function [see Clinical Pharmacology (12. Due to the limited extent of levofloxacin metabolism, the pharmacokinetics of levofloxacin are not expected to be affected by hepatic impairment. Chemically, levofloxacin, a chiral fluorinated carboxyquinolone, is the pure 29 (-)-(S)-enantiomer of the racemic drug substance ofloxacin.

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In idiopathic generalized tonic-clonic epilepsy, 7% to 10% of relatives nence, injuries, and tongue biting may occur. The postictal period is characterized of patients have a history of seizures, which is significantly higher than the gen by confusion and then sleep. Partial (focal) motor seizures are characterized by retention of consciousness, Heredity does not seem to play a role in symptomatic partial epilepsy. In with tonic or clonic jerking movements of the involved body part, usually unilat benign focal epilepsy of childhood, a family history of seizures can be elicited in eral face, arm, or leg. In complex partial seizures, the onset sometimes occurs with a blank stare, Pathology: In idiopathic epilepsy (generalized and partial), there are no consis unresponsiveness, and automatisms consisting of nonpurposeful movements, such tent specific anatomic or biochemical abnormalities. Episodes may be preceded by tonic-clonic epilepsy, however, microdysgenesis has been described. In the partial motor epilepsies may occur secondary to many types of localized benign focal epilepsy of childhood, the seizures are usually focal motor, involv structural lesions in the central cortex, including neoplasms (benign and malig ing the face and arm, as well as generalized tonic-clonic seizures. In complex partial seizures, hippocampal sclerosis is present in 30% to 50% Course: In idiopathic generalized tonic-clonic epilepsy, the prognosis is good, of patients. Less common with 80% of patients experiencing a five-year remission off anticonvulsant med lesions include post-traumatic cicatrix, hematomas, vascular malformations, and ications in the first 20 years after onset. The course of the sleep-related symptoms is not known, No lesions have been described that are specific to sleep-related epilepsy. Most patients with recurrent Complications: Acute complications of a generalized tonic-clonic seizure sleep-related epileptic seizures continue to have the seizures restricted to sleep. Spontaneous remission does tions, the patient may experience significant psychosocial effects, with education not usually occur, and as many as 35% of cases may prove to be refractory to or employment difficulties. In benign focal epilepsy of childhood, the prognosis is excellent, as virtually all patients have a remission by the age of Polysomnographic Features: the characteristic interictal abnormalities on 15 to 18 years. Focal or unilateral spikes also may appear as a partial expression Diagnostic Criteria: Sleep-Related Epilepsy (345) of the generalized seizure disorder. The patient has a complaint of one of the following: abrupt awakenings at pressed in frequency, or they disappear. Generalized tonic-clonic movements of the limbs In partial epilepsy, the characteristic abnormality is a spike or sharp transient 2. Tongue biting activity may remain localized or may show spread to adjacent areas or, at times, 6. Postictal confusion and lethargy In benign focal epilepsy of childhood, the interictal high-amplitude negative D. Polysomnographic monitoring demonstrates either of the foloowing: sharp waves have a characteristic and stereotyped morphology. The symptoms do not meet the diagnostic criteria for any other sleep disorder activating procedures is the most useful diagnostic test for most patients with. An overnight polysomnographic study can be useful in many patients, Note: the specific seizure-disorder type is specified and coded. When a primary sleep disorder is included in the differential diag nosis of an abnormal nocturnal event, all-night polysomnography can be helpful Minimal Criteria: A plus B plus C. Additional information can be obtained by simultaneous audio Severe: Sleep-related seizures occur almost nightly, often associated with phys visual monitoring and polygraphic recording of other physiologic measures. A computed tomographic scan or magnetic resonance imaging scan of the brain is usually indicated in Acute: 1 month or less. Differential Diagnosis: If generalized tonic-clonic seizures are restricted to Bibliography: sleep, a clear description of the event may not be obtained. Two groups of patients can be distinguished: ing sleep, nonconvulsive status epilepticus. The term electrical status epilepticus of sleep is preferred; however, the term is not ideal for a disorder that does not 1. The disorder is typically present in children and is not directly associated with clinical features. The disorder persists for months and often for more than sleep onset may show interictal electroencephalographic abnormalities such as one year. The spike and slow-wave discharge is so prevalent that spindles, K-complexes, or vertex sharp transients are seldom able to be distinguished. The exact duration is difficult to establish but ranges between several months and a few years. Other Laboratory Test Features: Routine daytime electroencephalographic recordings can show bursts of generalized spike and slow-wave discharges, often Predisposing Factors: None known. Differential Diagnosis: Three syndromes must be considered in the differen tial diagnosis: Sex Ratio: No difference. The interictal features of benign epilep studies of siblings and parents have not been reported. Moreover, because the con sy of childhood with Rolandic spikes are also characteristic. The sleep of dition has only been recognized since 1971 and because it exists only in child patients with benign epilepsy of childhood with Rolandic spikes does not hood, no information is yet available concerning the offspring of patients. Lennox-Gastaut Syndrome: the presence of tonic seizures in Lennox Pathology: Not known. Electrical status epilepticus during sleep retained for patients with acquired aphasia without continuous spike and in children (electrical status epilepticus of sleep). The disorder is usually asymptomatic, but there may be a complaint of dif ficulty in awakening in the morning. Other medical or mental disorders, particularly other seizure disorders, can migraine are severe, mainly unilateral, headaches that often have their be present. The symptoms do not meet the diagnostic criteria for other sleep disorders the patient is either awakened with pain during the night or is aware of an that occur during sleep. Migraine is a familial disorder characterized by recurrent attacks of headache that are widely variable in intensity, frequency, Minimal Criteria: A plus C plus D. Cluster headache is an extremely severe, unilateral headache often accompanied by symptoms of Severity Criteria: autonomic dysfunction. The relative frequency of cluster-headache ciated with transitory neuropsychologic disturbances. Daytime attacks often begin during naps or periods of physical relax ated with severe neuropsychologic disturbances. Associated Features: Classic migraine is usually associated with prodromes Chronic: 1 year or longer. The attacks are often accompanied by nausea, Billard C, Autret A, Laffont F, Lucas B, Degiovanni E. Electrical status epilepticus during sleep in chil loss of appetite, photophobia, and vomiting. Sleep and dominantly in males; the pain usually begins around or above one eye and usual epilepsy. Epilepsie partielle benigne ciating pain is accompanied by signs and symptoms suggesting autonomic dys et etat de mal electroencephalographique pendant le sommeil. The attacks may per Other Laboratory Test Features: Other diagnostic procedures can include sist throughout life; not infrequently, however, they may cease after menopause in brain imaging or electroencephalography. Remissions in sleep-related cluster headache usually last between six Differential Diagnosis: the differential diagnosis of sleep-related vascular months and two years and may also occur during pregnancy. Tension headaches are extremely common and are usually bilateral or have a midline distribution. Headaches due to Precipitating Factors: Migraine can be precipitated by sleep, stress, relaxation increased intracranial pressure, as with tumors, arteriovenous malformations, and after stress, trauma, barometric pressure and weather changes, foods, and eating hematomas; headaches due to cardiovascular disease and hypertension or inflam habits. Small doses of alcohol can trigger attacks in most patients with cluster matory conditions of bones, nerves, and meninges; and pos-ttraumatic headaches headache. Obstructive sleep apnea syndrome is a common cause of major triggering events in cluster headache.

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Epidemiological studies of work with video display terminals and adverse pregnancy outcomes (1984-1992). Safety of magnetic resonance imaging in patients with implanted cardiovascular devices. Editorial comment: mobile telephones and implantable cardioverter defibrillators. Nature of the changes in metabolic indices under the effect of radio waves of nonthermal intensity. Static electromagnetic fields generated by corrosion currents inhibit human osteoblast differentiation. Periprosthetic electrochemical corrosion of titanium and titanium-based alloys as a cause of spinal fusion failure. The electroporation effects of high power pulse microwave and electromagnetic pulse irradiation on the membranes of cardiomyocyte cells and the mechanism therein involved. The influence of variable and constant magnetic fields on biota and biological activity of ordinary chernozem soils. Effect of electromagnetic field accompanying the magnetic resonance imaging on human heart rate variability-a pilot study. Is there any risk interaction between electromagnetic field generated by mobile phones and artificial pacemakers. Archives des maladies professionnelles de medecine du travail et de securite sociale. Environmental and health investigation in female workers exposed to a radiofrequency electromagnetic field. Extremely low frequency electromagnetic fields affect proliferation and mitochondrial activity of human cancer cell lines. Permeability changes of cationic liposomes loaded with carbonic anhydrase induced by millimeter waves radiation. Di Giampaolo L, Di Donato A, Antonucci A, Paiardini G, Travaglini P, Spagnoli G, et al. Follow up study on the immune response to low frequency electromagnetic fields in men and women working in a museum. The effect of an ultrahigh frequency electromagnetic field on the functional status of the myocardium. A simple experiment to study electromagnetic field effects: protection induced by short-term exposures to 60 Hz magnetic fields. Short-term magnetic field exposures (60 Hz) induce protection against ultraviolet radiation damage. Effects of electromagnetic radiation on implantation and intrauterine development of the rat. Effect of wide-band modulated electromagnetic fields on the workers of high-frequency telephone exchanges. Effect of electromagnetic pulse exposure on brain micro vascular permeability in rats. Increase in hypoxanthine-guanine phosphoribosyl transferase gene mutations by exposure to electric field. Anxiety-like behavioural effects of extremely low-frequency electromagnetic field in rats. Mortality by neoplasia and cellular telephone base stations in the Belo Horizonte municipality, Minas Gerais state, Brazil. Trends in nonionizing electomagnetic radiation bioeffects research and related occupational health aspects. International trends in electromagnetic radiation bioeffects research proceedings. Influence of electromagnetic rays caused by cellular communication devices on human health (review of literature). The effect of electromagnetic radiation on the monoamine oxidase A activity in the rat brain. Epidemiological evidence of the effects of behaviour and the environment on the risk of human cancer. Recent results in cancer research Fortschritte der Krebsforschung Progres dans les recherches sur le cancer. Assessment of the hazards of electromagnetic fields emitted by the equipment aboard towards humans (nervous and circulatory systems). Analysis of short and long term therapeutic effects of radiofrequency hyperthermia combined with conformal radiotherapy in hepatocellular carcinoma. Childhood cancer in relation to distance from high voltage power lines in England and Wales: a case-control study. The influence of ultrasound and constant magnetic field on gametes, zygotes, and embryos of the sea urchin. Observations of changes in neurobehavioral functions in workers exposed to high-frequency radiation. Effect of static magnetic field on development toxicity of rat embryonic midbrain neurons cells. The preventive effect of lotus seedpod procyanidins on cognitive impairment and oxidative damage induced by extremely low frequency electromagnetic field exposure. Electromagnetic interference with implantable cardiac pacemakers by video capsule. Electromagnetic interference from wireless video-capsule endoscopy on implantable cardioverter-defibrillators. Hygienic standards for electromagnetic fields taking into account species traits and the time of action of the factor. Meteorological radars as an energy source of a superhigh-frequency range electromagnetic field and environmental hygiene problems. Effect of a low-frequency (50 Hz) electromagnetic field on the functional state of the human body. Hygienic evaluation of the electromagnetic field created by high-voltage electric power transmission lines. Industrial-frequency electromagnetic field as an environmental factor and its hygienic regulation. Activity of enzymatic systems exposed to a superhigh-frequency electromagnetic field. Hygienic evaluation of electromagnetic fields in the 17 cm range based on research data on behavioral reactions. Contribution of physical factors to the complex anthropogenic load in an industrial town. Evaluation of electromagnetic incompatibility concerns for deep brain stimulators. Effect of an industrial-frequency electromagnetic field on the nature of the growth and mitotic activity of cultured human fibroblast-like cells. Effect of an industrial frequency electromagnetic field on the testes of laboratory mice. Calcium and magnesium content in the tissues of rats exposed to an industrial-frequency electromagnetic field. Effects of exposure to a 60-kV/m, 60-Hz electric field on the social behavior of baboons. Description of a new computer wire coding method and its application to evaluate potential control selection bias in the Savitz et al. Magnetic field on the deranged accommodation of visual detector terminal operators. Clinical efficacy and safety evaluation of a monopolar radiofrequency device with a new vibration handpiece for the treatment of facial skin laxity: a 10-month experience with 64 patients. The acute effects of radiofrequency energy in articular cartilage: an in vitro study. Health care utilisation and attitudes towards health care in subjects reporting environmental annoyance from electricity and chemicals.

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Spreeadsheet conntaining list oof all distinguuished personns Metadatta collection During thhe first project meeting inn January 20017 it was deecided that thhe process of collectting metadata will be perrformed as ffollows: in thhe repositoryy of a par ticipatingg institution, the digitizedd objects havving a particcular person as the au thor or thhe subject, wwill be selecteed, with all mmetadata inccluded. Local identifiers from each repository have been replaced by a global standard identifier that is unique in all repositories from which the data are selected. This solution has enabled the aggregation of heterogeneous data from different repositories and their inte gration into the portal Znameniti. This portal showed how important it is to develop an aggregate system that collects data from different digital sources. The photographs of distinguished per sons, which follow immediately after the home page and offer the ability to browse through the content of the portal ure 3), are put forward. In the left column, they are arranged in two groups of facets: Izvor zapisa (source record, i. Besides the name authority records data base, there is a lack of services for integration and unified search of other authorita tive records. The idea of developing the Croatian Europeana, initially formu lated in parallel with the development of the aggregating system but for differ ent reasons still unrealised, now seems within reach by the development of the cooperation portal. In the beginning, all the data and the portal application were hosted at the server of the company responsible for the application development znameniti. Thee main precondition for ddeveloping thhis kind of portal is the existencce of digital resources wwith accompaanying metadadata. This can faciliitate the rettrieval and pprovide a unnified approoach to all ddigital re sources. Currentlyy in Croatia tthere is relattively modesst number off repositoriess and they are not innterconnectedd. There are also digital materials thaat are not preeserved in an adequaate manner aand are not ppublished onn Internet, thherefore not publically available. Collectinng the re lated recoords will alloow their orgaanization on a unique porrtal. It is expected that the number of participating cultural and sci entific institutions will grow as well as the number of included digital records on the distinguished persons. In the beginning of the project, four institutions were involved, but now four more institutions are showing their interest in col laboration and systematic collecting, publishing and interlinking of digital re sources. That is why it was agreed that the cooperation of these eight institu tions will continue, that the selected representatives from those institutions will form a coordination committee, and to define the cooperation through a special agreement. Other institutions, having similar digital records, are also showing interest to contribute to the Znameniti. In the initial phase, the cooperation may be realized by connecting the thematically organized metadata. This might be the foundation for development of the national cultural digital infrastructure. This portal is a great example in the still developing digital humanities area showing how digital materials, when processed by the cultural institutions, can become an important resource for education and science usable in the curriculum. We propose a set of evaluation criteria relevant for a sign language dictionary and point out why sign language dictionaries should transcend the traditional printed formats. The evaluation criteria described in this paper will in further research be used as an evaluation instrument of some existing online sign language dictionaries to assess the instrument. Moreover, most of those reviews were unfavourably judged by other lexicographers, mainly for the lack of objective standards (Swanepoel 2008: 209). In this paper we describe the features of Croatian sign language, investigate characteristics of dictionaries of signed languages, and examine evaluation criteria for different types of printed and online dictionaries. We propose a set of evaluation criteria as an instrument for evaluation of online dictionaries of sign languages, thereby hoping to contribute to an improvement in the quality of dictionary criticism in the field of sign language lexicography. About sign languages 1 In this section we bring a brief overview of features of a sign language. Unlike the oral-auditory modality of spoken languages, sign languages have visual-spatial modality. From this difference in modality stem many issues in writing any sign language down and creating a dictionary of a signed language, as will be shown in the next section. While organizing this section, we had the characteristics of the Croatian Sign Language in mind. However, while compiling the evaluation instrument, we took into account characteristics of other sign languages. A person with progressive visual impairment or with constant visual impairment with deafness forecast can also be considered as Deafblind. Also, this classification covers the Deafblind with characteristic syndromes (Usher syndrome, Charge syndrome). Bago, An instrument for evaluation of online dictionaries of sign languages th Sign languages were first systematically described in the middle of the 20 century. The five elements of a sign are handshape, location, movement, orientation, and non-manual markers. Orientation element is the distinctive degree of rotation of the hand in relation to the signer. They are different from phonemes of a spoken language in that they often appear simultaneously. A sign conveys a concept, not an English word, and the production of a sign involves five elements that need to be described" 4 (Tennant, Gluszak Brown 1998: 26). Those notation systems use symbols and abstract pictures to describe a sign and all its elements, and are not written in a single line but also use the vertical plane to add information. There are some modifications to the signs depending on the quantity of subjects and/or objects, but signers often use the canonical form of nouns and adjectives in combination with pronouns, adverbs, and prepositions (which can often be modified. A dictionary of American Sign Language on linguistic principles by Stokoe, William C. Those first dictionaries usually chose their entries on a basis of a dictionary of a spoken language. Creating a corpus for a dictionary of a signed language mostly takes several deaf people who are given topics to talk about while being recorded. In such way lexicographers can find out which signs are the more frequent ones, how the signs are used and what meanings they carry. Since sign languages have a different modality from spoken ones, it is difficult to print a dictionary that will provide enough visual-spatial information that could easily be understood. Some dictionaries use one of the existing notation systems to try to convey more information. It is not by any means evident that most diction ary users are prepared to make this kind of investment" (Singleton 2000: 205). Therefore it is much easier to use dictionaries that rely on pictures with descriptions of signs. There is a traditional printed dictionary 8 9 "Hrvatski znakovni jezik" by a group of editors which was published in 2015. Another tends to be a specialised dictionary: "Gluhi i znakovno medicinsko nazivlje: kako 10 11 komunicirati s gluhim pacijentom" published in 2010. While the entries in the general dictionary section only consist of a gloss and a picture, the medical ones include a short definition. To make it easier to apply objective criteria, a kind of a measuring system had to be made. Researchers made lists of points one should mention in a review, or evaluation criteria. Haas lists 12 desiderata (as cited in Landau 2011: 11) any bilingual dictionary should contain, while Landau (2011: 11) notes some limits which those needed elements set for each other: 1. Jackson (1996: 7-11) proposes a range of vocabulary, word formation, homographs, defining, sense division, lexical relations, collocations, connotations, pronunciation, grammar, usage, examples, etymology, and special features as the main criteria for evaluating a dictionary. More recent criteria for dictionary criticism could be divided into categories like the ones Svensen (2009: 483) lists: dictionary functions, dictionary users, advice given to the users, price, layout / web design, the compiler(s), comparison with other dictionaries, prehistory of the dictionary, reference to other reviews, the reviewer, dictionary basis, outside matter, lemma selection, establishment of lemmas, search and access options, entry structure, the normative/descriptive dimension, equivalents, grammar, orthography, pronunciation, semantic and encyclopaedic information, diasystematic information, etymology, examples, collocations, idioms, illustrations, synonymy/antonymy, cross-references, entertainment value, and unified concluding evaluation. This list already mentions some elements which can only be applied to e-dictionaries, such as 194 K.

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However, even in the absence of the real-life missing components (which tend to enhance the adverse effects of the wireless radiation), the literature shows there is much valid reason for concern about potential adverse health effects from both 4G and 5G technology. The studies reported in the literature should be viewed as extremely conservative, underestimating the adverse impacts substantially. The electromagnetic spectrum encompasses the entire span of electromagnetic radiation. The spectrum includes: ionizing radiation (gamma rays, x-rays, and the extreme ultraviolet, with 7 15 wavelengths below ~10 m and frequencies above ~3x10 Hz); non-ionizing 7 7 visible radiation (wavelengths from ~4x10 m to ~7x10 m and frequencies 14 14 between ~4. Because of present concerns about the rapid expansion of new communications systems without adequate safety testing, more emphasis will be placed on the communications frequencies in this document. Now, many varieties of articial light (incandescent, uorescent, and light emitting diode) have replaced the sun as the main supplier of visible radiation during waking hours. In the last two or three decades, the explosive growth in the cellular telephone industry has placed many residences in metropolitan areas within less than a mile of a cell tower. Future implementation of the next generation of mobile networking technology, 5G, will increase the cell tower densities by an order of magnitude. There are three main reasons the laboratory tests do not reflect real-life exposure conditions for human beings. First, the laboratory tests have been performed mainly on animals, especially rats and mice. Because of physiological differences, there have been continual concerns about extrapolating small animal results to human beings. Additionally, while inhaled or ingested substances can be scaled from small animals to human beings relatively straight-forwardly, radiation may be more problematical. This contradicts real-life exposures, where humans are exposed to multiple toxic stimuli, in parallel or over time. Thus, almost all of the laboratory tests that have been performed are flawed with respect to showing the full adverse impact of the wireless radiation. Either 1) non-inclusion of signal information or 2) using single stressors only 3) tends to underestimate the seriousness of the adverse effects from non-ionizing radiation. Excluding both of these phenomena from experiments, as was done in the vast majority of cases, tends to amplify this underestimation substantially. The epidemiology studies typically involved human beings, who had been subjected to myriad known and unknown stressors prior to (and during) the study. I believe the inclusion of real-world effects in the cell tower studies accounted for the orders of magnitude exposure level decreases that were associated with the increased cancer incidence. Thus, the laboratory tests were conducted under very controlled conditions not reflective of the real-world, while the epidemiology studies were performed in the presence of many stressors, known and unknown, reflective of the real-world. The exposure levels of the epidemiology studies were, for the most part, uncontrolled. Extensive reviews of these wireless radiation biological and health effects have been published, including [Kostoff and Lau, 2017; Panagopoulos, 2019; Belpomme et al, 2018; Desai et al, 2009; Di Ciaula, 2018; Doyon and Johansson, 2017; Havas, 2017; Kaplan et al, 2016; Lerchl et al, 2015; Levitt and Lai, 2010; Miller et al, 2019; Pall, 2016, 2018; Panagopoulos, 2019; Panagopoulos et al, 2019; Russell, 2018; Sage and Burgio, 2018; Van Rongen et al, 2009; Yakymenko et al, 2016; Bioinitiative, 2019]. The effects range from myriad feelings of discomfort to life threatening diseases. Penetration depths for the carrier frequency component of 5G radiation will be on the order of a few millimeters. At these wavelengths, one can expect resonance phenomena with small-scale human structures [Betzalel, 2018], as well as resonances with insects/insect components. However, there is evidence that biological responses to millimeter wave irradiation can be initiated within the skin, and the subsequent systemic signaling in the skin can result in physiological effects on the nervous system, heart, and immune system [Russel, 2018]. This is one of many translations of articles produced in the Former Soviet Union on wireless radiation (also, see reviews of Soviet research on this topic by McRee [1979, 1980]). Not only was skin impacted adversely, but also heart, liver, kidney, spleen tissue as well, and blood and bone marrow properties. These results reinforce the conclusion of Russel (quoted above) that systemic results may occur from millimeter-wave radiation. Thus, the expected real-world results (when human beings are impacted, the signals are pulsed and modulated, and there is exposure to many toxic stimuli) would be far more serious and would be initiated at lower (perhaps much lower) power fluxes. What national security concerns caused it (and the other papers in the linked pdf reference) to be classified in the first place, and then kept classified for 35 years until declassification in 2012 It appears that we have known about the potentially damaging effects of millimeter-wave radiation on the skin (and other major systems in the body) for over forty years, yet the discourse today only revolves around the possibility of modest potential effects on the skin and perhaps cataracts from millimeter-wave radiation. Alternatively, in this specific example, the carrier signal and the information signal could be viewed as a combination of potentially toxic stimuli, where the adverse effects of each component are enabled because of the synergistic effects of the combination. If these results can be extrapolated across species, then human beings could exhibit different responses to the same electromagnetic stimuli based on their genetic predispositions. For example, studies have shown that industry-funded research of wireless radiation adverse health effects is far more likely to show no effects than funding from non-industry sources [Huss et al, 2007; Slesin, 2006; Carpenter, 2019]. Unfortunately, given the strong dependence of the civilian and military economies on wireless radiation, incentives for identifying adverse health effects from wireless radiation are minimal and disincentives are many. These perverse incentives apply not only to the sponsors of research and development, but to the performers as well. Even the Gold Standard for research credibility independent replication of research results is questionable in politically, commercially, and militarily sensitive areas like wireless radiation safety. Suppose there are two research groups (funded by the same government agency) who both arrive at the same conclusion that just coincidentally coincides with what the government sponsor wanted. Or, these two research groups received funding from different agencies of the government. Given the broad support exhibited today by the government, military, and industry for the rapid implementation of 5G, all these organizations have to present a united front in declaring 5G (and previous generations of mobile networking technology) to be safe. Even reporting of conflict-of-interest on wireless radiation research papers or evaluation panels leaves much to be desired. Currently, potential conflicts of interest of the research performers are identified by listing of funding sources in the published papers, or other formal documented evidence of conflicts of interest. Unfortunately, there is a large body of data from laboratory and epidemiological studies showing that previous generations of wireless networking technology have significant adverse health impacts. When real-world considerations are added, such as 1) including the information content of signals along with 2) the carrier frequencies, and 3) including other toxic stimuli in combination with the wireless radiation, the adverse effects are increased substantially. Superimposing 5G radiation on an already imbedded toxic wireless radiation environment will exacerbate the adverse health effects shown to exist. Far more research and testing of potential 5G health effects is required before further rollout can be justified. Thermal and non thermal health effects of low intensity non-ionizing radiation: An international perspective. BioInitiative Report: A Rationale for Biologically-based Public Exposure Standards for Electromagnetic Radiation at Extremely low frequency electromagnetic fields and cancer: How source of funding affects results. Pathophysiology of cell phone radiation: oxidative stress and carcinogenesis with focus on male reproductive system. Electromagnetic fields may act via calcineurin inhibition to suppress immunity, thereby increasing risk for opportunistic infection: Conceivable mechanisms of action. Significant differences in the effects of magnetic field exposure on 7, 12-dimethylbenz(a)anthracene-induced mammary carcinogenesis in two substrains of Sprague-Dawley rats.

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Men 21-42 Medical History If you do not have varicose veins or edema, monitor your legs regularly and Q6, Q7, and Q9 >18 have them checked by your vascular specialist Remember to eat a balanced diet depending on your basal metabolism. You need to stop the progression of the disease by medical management (phlebotropic drug treatment, compression stockings, etc) and maintain the results obtained by a lifestyle that promotes healthy veins. Prefer an antifluid retention diet by drinking water, tea, and herbal tea Symptoms and choosing vegetables known for their fluid elimination properties Q2, Q3, and Q4 >6 (artichokes, black radish, asparagus, leeks, etc) Undergo lymphatic drainage and/or pressure therapy. Actions to take by subjects presenting with chronic venous disorders or disease according to their Phleboscore results. Phleboscore 75116-Paris, France should help to more accurately identify the patients at risk of developing a more serious disease so that interventions can be offered at an early stage to those who will gain the most benefit. Risk indicators for of the lower limbs: guidelines according varicose veins: the Framingham Study. Oral contraceptives intake may be Prevalence of primary chronic venous 2007;46:331-337. Schultz-Ehrenburg U, Weindorf of sex-related and lifestyle risk factors in N, Von Uslar D, et al. Importance of Prevalence of varicose veins and chronic the familial factor in varicose disease. Lifestyle risk factors for lower limb venous reflux in the general population: Edinburgh Vein Study. Chronic venous disease progression epidemiological study in England and high degree of venous reflux during and modification of predisposing factors. For postthrombotic syndrome, duplex ultrasound can recognize specific anatomical abnormalities in the venous lumen, wall, and valves. Reflux can be easily diagnosed with duplex ultrasound, although some controversy is present concerning the extent of the reflux detected compared with descending venography. Before operative recanalization, duplex ultrasound can be used to determine the procedure, feasibility, expected permeability, and safest venous access site; evaluate suprainguinal venous segments and infrainguinal vessels to determine the landing zone; distinguish between postthrombotic syndrome, primary and congenital incompetence, or compression. Duplex ultrasound is currently used during postoperative follow-up after repermeation and stenting to determine Keywords: the permeability of the stented veins and recognize complications, such as deep vein refux; duplex ultrasound; thrombosis, residual stenosis, and intrastent intimal hyperplasia. Currently, duplex iliofemoral obstruction; postthrombotic ultrasound is the first-line examination for postthrombotic syndrome diagnosis, syndrome; venous stenting preoperative investigation, and postoperative follow-up because it provides relevant information for the operative management of obstruction and reflux, even if the preoperative assessment must be completed by venography and other instrumental investigations. Introduction Postthrombotic syndrome includes all of the venous signs and symptoms occurring after a deep venous thrombosis in the lower limb. Diagnostic and quantification of postthrombotic syndrome are based on clinical criteria, which are described For postthrombotic syndrome, duplex techniques offers appealing treatment possibilities, even for ultrasound checks for deep venous reflux at the femoral and patients without tissue damage, that are complementary to popliteal veins in patients who are standing and it uses a conservative treatments. Obstruction is resulting in low morbidity and mortality, and effective, with measured using an augmentation maneuver in patients in a high rate of technical success, patency, ulcer healing, and a supine position. Deep veins abnormalities In addition to a physical examination, duplex ultrasound is Anatomical abnormalities a mandatory and complementary assessment for patients At the acute stage of an obstructive deep venous presenting with chronic venous disease. Current guidelines thrombosis, the occluded vein appears as a dilated and strongly recommend using duplex ultrasound as the primary noncompressible vein with a clot filling the lumen of the diagnostic test for superficial venous insufficiency, suspected vein that is more or less echolucent according to the age of abdominal or pelvic venous pathology, postthrombotic the thrombus. For a nonocclusive thrombosis, the thrombus syndrome, or clinical suspicion of other forms of iliac or is usually floating in the lumen of a nondilated vein. Duplex the other hand, according to the depth of the veins, duplex ultrasound techniques have been extensively described in ultrasound is usually more precise for infrainguinal vein consensus documents. Basic duplex ultrasound examination of superficial veins includes assessing perforating veins and all of the saphenous vein junctions, trunks, and tributaries. The hemodynamic analysis is used to diagnose reflux elicited by the calf compression release maneuver and/or the Valsalva maneuver. The anatomical analysis measures the diameter of the refluxing saphenous trunks, which is measured 15 cm away from the saphenofemoral junction for the greater saphenous vein, at mid-calf for the small saphenous vein, and at the fascia for perforating veins. Residual fibrotic thrombus* in the left external iliac vein commonly reported on cartography. According to the extent of the lysis, the following complete recanalization of the vein without any abnormality. Duplex ultrasound is a very efficient technique, but there is some controversy concerning the evaluation of reflux extension compared with descending venography. In a normal patent vein, spontaneous blood velocities are low and they increase significantly with an augmentation maneuver. In this case, color Doppler shows a complete and homogenous filling of the lumen and pulsed Doppler shows an increase in the flow velocities with a steep slope of the curve. Furthermore, proximal veins, such as the iliac and common femoral veins, present a phasic flow with respiratory modulation. An increase in velocity is observed at a segmental femoral veins using a compression-release maneuver of the stenosis. In the last two cases, color Doppler shows an limb distal to the point of examination in a patient that is irregular colorization of the vein lumen compared with standing. A color Doppler ultrasound investigation is used a patent healthy vein ure 9). In a second step, a power Doppler performed proximally to an obstructive area, the duplex ultrasound can measure reflux duration that must exceed the ultrasound will demonstrate a low increase in venous 105 Phlebolymphology Vol 23. Increase in venous flux velocities at the termination of the left iliac vein (Panel A) compared with velocities measured distally to the stenosis (Panel B) (spontaneous flow). For example, for postthrombotic syndrome, spontaneous high flow velocity in the great saphenous vein indicates that there is an obstruction of the infrainguinal deep vein. For supra inguinal postthrombotic syndrome, retrograde flow into the internal iliac vein indicates that there is an obstruction of the common iliac vein and other deep collateral veins can also be identified. Superficial venous insufficiency can be present in postthrombotic syndrome Figure 9. Color Doppler ultrasound of the popliteal vein and can sometimes be worsened by deep venous reflux (longitudinal view). Duplex ultrasound examination of the There is a partial recanalization with irregular colorization of superficial vein for postthrombotic syndrome is the same the lumen vein. For postthrombotic velocity during an augmentation maneuver with a flat syndrome, superficial collateral veins can be dilated and slope of the waveform that is asymmetrical compared with tortuous and they can mimic varicose veins. These features are commonly observed at the common femoral vein usually disappears and a spontaneous thigh and abdomen. If the varicose vein reflux originates low velocity flux can be observed ure 11). As lower-limb veins are often with a bidirectional perforating vein, duplex ultrasound duplicated or triplicated and connected with numerous must search for the source of the perforating venous reflux, collateral veins, a collateral pathway develops when deep which can be increased by reflux in an axial or a major vein thrombosis occurs and this network may or may not deep vein. Normal (Panel A) and pathological (Panel B) velocity profiles during an augmentation maneuver. Right common femoral vein flux with a patent and healthy right iliac vein (Panel A) and left common femoral vein flux with left iliac vein obstruction (Panel B). Some collateral veins Supra-inguinal obstruction can usually be recognized with duplex ultrasound, such Iliac vein obstruction can be related to postthrombotic as the superficial suprapubic vein (Palma collateral veins) syndrome, but also to other conditions, such as the May or the lateral abdominal collateral vein (for inferior vena Thurner syndrome (left common iliac vein compression cava obstruction), but also deep veins involving the latero between the right iliac artery and the spine), other iliac vein uterine, ovarian, and lumbar veins can be identified. In compressions, or congenital deep venous anomalies, such some cases, collateral veins can mimic the course of the as inferior vena cava atresia. High For the May-Thurner syndrome, indirect hemodynamic venous pressure can be responsible for an increase in the anomalies of obstruction are present on the left side and femoral vein diameter compared with the contralateral deep collateral veins can be observed. The termination of the common iliac vein appears to be compressed by the right common For postthrombotic syndrome, anatomical and iliac artery with a decrease in the vein diameter and an hemodynamic direct abnormalities (as described above) increase in the flux velocity. Proximally to the compression, can be observed at the common iliac vein and/or at an 107 Phlebolymphology Vol 23. For other compressions, duplex ultrasound and superficial venous reflux, insofar as refluxing superficial can often identify the cause of the compression (tumor veins can also act as a collateral pathway. For inferior vena cava atresia, saphenous vein appears to be refluxing in a standing duplex ultrasound shows the absence of a normal inferior position with a compression-release maneuver, it can also vena cava in the atretic area and usually obvious collateral be efficient as a collateral pathway during exercise. If the great saphenous vein appears to be refluxing during exercise and/or if the deep venous flow increases during great saphenous vein compression, reflux is probably predominant compared with the collateral efficacy. Infrainguinal abnormalities Combination of superficial and deep venous reflux At the infrainguinal level, the combination of superficial and deep venous reflux is common, and normally, both can be easily evaluated. For combined reflux in the common femoral vein and the great saphenous vein or in the popliteal vein Figure 13.

References:

  • https://www.nhsaaa.net/media/6864/2019-04-18-rsv-sop-v013.pdf
  • https://web.duke.edu/pathology/siteParts/avaps/06.15.1_Liver_Pathology_Final.pdf
  • https://adrccares.org/wp-content/uploads/2016/01/alzheimers_disease_unraveling_the_mystery_0.pdf
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