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The affected person is usually unable to accept the burden of bedclothes on the joint and unable to Page 50 bear weight on the affected joint. Associated Symptoms In the acute phase, sufferers may be be} febrile and have leukocytosis. Signs Redness, heat, and tender swelling of the joint, which can be extraordinarily painful to move. Usual Course Initially the disorder is monoarticular; in 50% of sufferers the primary metatarso-phalangeal joint is concerned within the great toe. Attacks could turn into polyarticular and recur at shorter intervals and will finally resolve incompletely leaving chronic, progressive crippling arthritis. Relief Responds well to nonsteroidal anti-inflammatory brokers, intravenous colchine, and local steroid injections. Complications Renal calculi, tophaceous deposits, and chronic arthritis with joint harm. Demonstration of intracellular sodium urate monohydrate crystals in synovial fluid leukocytes by polarizing microscopy or different acceptable strategies of identifying crystals. Demonstration of sodium urate monohydrate crystals in an aspirate or biopsy of a tophus by strategies just like those in 1. In the absence of particular crystal identification, a history of monoarticular arthritis followed by an asymptomatic intercritical interval, rapid decision of synovitis following Colchicine administration, and the presence of hyperuricemia. Differential Diagnosis Calcium pyrophosphate deposition disease, an infection, palindromic rheumatism. Hemophilic Arthropathy (1-14) Definition Bouts of acute, constant, nagging, burning, bursting, and incapacitating ache or chronic, aching, nagging, gnawing, and grating ache occurring in sufferers with congenital blood coagulation issue deficiencies and secondary to hemarthrosis. As the primary joints turn into progressively affected, different remaining articular and muscle areas are concerned with adjustments of disuse atrophy or progressive hemorrhagic episodes. Main Features Prevalence: hemophilic joint hemorrhages occur in severely and reasonably affected male hemophiliacs. Acute hemarthrosis happens mostly within the juvenile in association with minor trauma. In the adult, spontaneous hemorrhages and ache occur in association also with minor or severe trauma. Characteristically the acute ache is related to such hemarthrosis, which is relieved by substitute remedy and rest of the affected limb. A reactive synovitis outcomes from repeated hemarthroses, which can be simply spontaneous small recurrent hemorrhages. The ache related to them is extraordinarily difficult to treat due to the underlying inflammatory response. [newline]Time Course: the acute ache is marked by fullness and stiffness and constant nagging, burning, or bursting qualities. It is incapacitating and can trigger severe ache for a minimum of|no less than} per week relying upon the diploma of intracapsular swelling and stress. Chronic ache is usually a dull ache, worse with movement, however can be debilitating, Page 51 gnawing, and grating. At the stage of harmful joint adjustments the chronic ache is unremitting and relieved primarily by rest and analgesics. These syndromes are exacerbated by accompanying joint and muscle degeneration due to of} lack of mobility quite than repeated hemorrhages. Associated Symptoms Depressive or passive/aggressive symptoms often accompany hemorrhages and are secondary to the extent of ache or to the belief of vulnerability to hemorrhage, which is past the management of the hemophiliac. Numerous psychosomatic complaints are related to the chronic and acute ache of chronic synovitis, arthritis, and hemarthrosis. Signs Reactive Synovitis: There is a chronic swelling of the joint with a "boggy" consistency to the swelling, which is tender to palpation. Marked limitation of joint movement often with indicators of adjoining involvement of muscle groups due to of} disuse atrophy. Chronic Joint Degeneration: Severe bony transforming with decrease in joint movement, adjoining muscular atrophy with subsequent fixation of the joint and loss of effective use. Laboratory Findings X-rays with the large hemarthrosis show little except for soft tissue swelling. Cysts, rarefactions, subcondylar cysts, and an overgrowth of the epiphysis are noted. This progresses through to fibrous joint contracture, loss of joint house, extensive enlargement of the epiphysis, and substantial disorganization of the joint structures. The articular cartilage reveals extensive degeneration with fibrillation and eburnated bone ends. Usual Course Until the supply of remedy with blood clotting issue focus, there was an inexorable deterioration of the affected joints following the preliminary repeated spontaneous hemarthroses within the severely affected particular person. This joint deterioration was related to ache as described within the section relating to time course. The introduction of concentrated clotting issue transfusions has avoided the consequence of repeated acute severe hemarthroses. Therapy with blood clotting issue focus is on the market a daily basis|regularly|frequently} only in North America and Europe right now. Relief Acute Hemarthrosis: Adequate intravenous substitute with acceptable coagulation components with subsequent graded exercise and physiotherapy will provide good aid. Reactive and Chronic Hemarthrosis: Prophylactic issue substitute is required in association with analgesics and carefully chosen antiinflammatory brokers. Pain management utilizing analgesics and transcutaneous nerve stimulation helpful, and physiotherapy is of considerable help in managing each symptoms and indicators. Synovectomy may be be} of use for the management of ache secondary to the recurrent bleeding. Chronic Destructive Arthropathy: Replacement remedy is of little help in relieving ache and disability. Carefully chosen antiinflammatory brokers and rest are the most important therapies of use. Complications Analgesic abuse is a standard downside in hemophilia due to of} the acute and chronic ache syndromes related to hemophilic arthropathy. This downside can be avoided within the youthful age group by not utilizing narcotic analgesics for chronic ache administration and relying upon ideas of comprehensive hemophilia care. These embody common physiotherapy, exercise, and making full use of obtainable social and skilled alternatives. Social and Physical Disability Severe crippling and bodily disability, with prolonged school and work absences, have historically been related to this form of arthropathy. It is taken into account that the higher suicide rate is related not only to the household and psychosocial aspects of the disease but additionally to the chronic ache syndromes that these individuals expertise. Phase one entails an early synovial soft tissue response caused by intraarticular bleeding. Synovial hypertrophy with hemosiderin deposition and delicate perivascular irritation are current. Cartilage degeneration and joint degeneration just like that seen in osteoarthritis and rheumatoid arthritis is seen within the sec- Page fifty two ond-phase joint. Associated with kind of|this sort of|this kind of} phase two change is synovial thickening and hyperplasia which falls into quite a few folds and clusters of villi. Summary of Essential Features and Diagnostic Criteria Acute and chronic ache as outcome of|the outcomes of} acute hemarthrosis with chronic synovial cartilaginous and bony degeneration is exacerbated by spontaneous and traumarelated hemorrhage. Diagnostic Criteria Pain related to hemophiliac arthropathy should fulfill each 1 and 2 of|and a pair of}. Spontaneous intracapsular hemorrhages in an individual with an inherited hemostatic defect. Any age can be affected, however the highest incidence (18%) is between 20 and 29 years. Children are the next largest group, with 30% of those being within the 1-2 12 months age group. It is regularly described as throbbing, smarting, and stinging, and marked exacerbations of stabbing ache occur with any movement or procedure. Despite the destruction of all cutaneous nerve endings, full thickness bums are often painful with a top quality|a high quality} described as deep, dull, or aching. Intensity and Duration: the ache tends to diminish in depth as therapeutic takes place. In addition, the standard of the ache adjustments, and at one to two weeks after the bum is often described as sore, aching, tender, tiring, and tight.

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Clinical Supports Questions · Does your group use a certifed electronic medical information system? Does your information system have a formal way of documenting bodily health-related services? Medications can relieve distressing symptoms and improve functioning for folks with mental sickness, and so they work in selection of|quite lots of|a wide selection of} methods. For instance, a medication could also be} referred to as an "antidepressant" but also assist with anxiousness or an consuming dysfunction. Antipsychotic medications are typically associated with illnesses like schizophrenia however may also be used for bipolar dysfunction or severe melancholy. Because the same medicine can be utilized to treat varied issues, all the time ask clients for which situation they take a medication. A person might have a history of taking completely different medications up to now or might report a change in his or her medications whereas working with a counselor. People need completely different medications depending on how their sickness is expressing itself. Medications used to treat the frst episode of a mental sickness could also be} completely different from these used later in disease course. Age might have an effect on} medicine selection and dosage; aging affects metabolism and the bioavailability of some medication. Sometimes a medication turns into less effective over time and should be modified or one other medicine added. Such conditions include when a consumer: · Has not had success enhancing symptoms Medication Management A person with a mental sickness must be cared for by a group of suppliers, which may include a main care supplier, a psychiatrist, and a behavioral well being professional, similar to a psychologist, social employee, or counselor. Medications will typically be prescribed by the first care supplier or psychiatrist. The group ought to work collectively to monitor the effects and unwanted effects effects} of the medicine. Equally necessary is knowing to whom refer clients for medicine evaluation. You ought to discuss with main care or behavioral well being professionals with prescribing privileges, similar to: · A doctor. This could also be} triggering for the consumer or these around him or her or lead to misuse of prescribed medicine. Illicit substances and prescribed medications might work together with one another, potentially decreasing the benefcial effects of the prescribed medicine (Lindsey, Stewart, & Childress, 2012). The spray (esketamine) is specifcally for treatment-resistant main melancholy and is designed to begin relieving symptoms, in a matter of hours. The goal of medicine is to relieve distressing symptoms and assist restore perform. Each works in numerous methods however ultimately treats melancholy by changing the steadiness of chemical compounds (neurotransmitters) in the mind that regulate temper, similar to serotonin, norepinephrine, and dopamine. Side Efects Common unwanted effects effects} when antidepressants are began or when the dose is increased are nausea, vomiting, and diarrhea (Exhibit 7. Side effects similar to weight acquire, sleep disturbances, and sexual dysfunction can be longer lasting. Some medicine unwanted effects effects} might mimic indicators of intoxication or withdrawal or could also be} triggering for clients. Some antidepressants are associated with birth defects or cause the newborn to experience a withdrawal syndrome. Medication for Anxiety Disorders Anxiety issues are greatest handled with combined psychotherapy and medicine (Benich, Bragg, & Freedy, 2016). More critical serotonin syndrome can look like intoxication with a stimulant or hallucinogen or withdrawal from a benzodiazepine. Benzodiazepines ought to usually be used just for quick intervals, taken per a schedule somewhat than as wanted (Benich et al. Benzodiazepines may cause dependence after relatively transient intervals of regular use. People depending on benzodiazepines will experience withdrawal if they that they} stop taking them abruptly. Side effects of antidepressants prescribed for anxiousness are the same as these for melancholy (Exhibit 7. Benzodiazepines carry an increased danger of central nervous system melancholy, which may lead to sedation, fatigue, dizziness, and impaired driving capacity (Bandelow, Michaelis, & Wedekind, 2017). Older adults taking benzodiazepines can have adverse changes in cognition, similar to memory, learning, and attention. Older adults taking benzodiazepines are thus at an increased danger of falls and fracture (Markota, Rummans, Bostwick, & Lapid, 2016). The goal of medicine in bipolar dysfunction is to stop or suppress mania whereas relieving melancholy (Fountoulakis et al. Sometimes folks will have already begun treatment for melancholy when mania presents for the frst time. Medications used to treat bipolar dysfunction are often referred to as "temper stabilizers. Mood stabilizers, antiseizure medications, and antipsychotic medications could also be} used to treat bipolar dysfunction; sometimes these medications are used in mixture. Mood Stabilizers Medication to stop severe temper fuctuations can be effective at treating mania, particularly the frst-line medicine lithium (Fountoulakis et al. Mood stabilizers treat and forestall mania by decreasing abnormal activity in the mind. People taking lithium need to see a doctor regularly for monitoring of blood ranges and kidney and thyroid functioning. Side effects that may improve with time are nausea, diarrhea, dizziness, muscle weak spot, fatigue, and feeling "dazed. [newline]Anesthesia and antidepressants are associated with serotonin syndrome when taken with lithium. Elevated blood ranges of lithium may cause uncontrollable shaking, clumsiness, ringing in the ears, slurred speech, and blurred vision. Salt, caffeine, alcohol, different medications, and dosing mistakes may cause lithium toxicity, which is usually a|could be a} medical emergency. Tobacco smoke affects how medications are absorbed, spread through the body, are metabolized, and eradicated by the body; how medications work can also be|may also be|can be} affected (Lucas & Martin, 2013). Changing the quantity of tobacco smoked, together with stopping or beginning, can intervene with medicine effectiveness or danger of unwanted effects effects}. Medication for Schizophrenia and Other Psychotic Disorders Antipsychotics are the commonest medications for schizophrenia and different psychotic issues (Lally & MacCabe, 2015; Patel, Cherian, Gohil, & Atkinson, 2014). Most are taken daily, however a couple of of} long-lasting varieties can be administered a couple of times a month. Antipsychotics are divided into two categories: "frst-generation" or "typical" antipsychotics and "second-generation" or "atypical" antipsychotics. Both varieties can be utilized to assist treat schizophrenia and mania related to bipolar dysfunction. Symptoms similar to agitation and hallucinations might remit inside a couple of of} days of beginning the medicine, whereas delusions might take a couple of of} weeks to resolve. Antiseizure Medication Antiepileptic medications can be utilized to treat bipolar dysfunction (Fountoulakis et al. These medications might have each benign and lifethreatening unwanted effects effects}, together with rash, damage to internal organs, and a lower in blood cells. These medications can work together negatively with medications used to treat frequent medical concerns, similar to diabetes and hypertension. Other critical unwanted effects effects} include peeling or blistering of the skin, bruising, bleeding, weak spot, headache, stiff neck, chest ache, nausea/vomiting, vision changes, swelling of the face/eyes/lips, darkish urine, yellowing of the skin or eyes, abnormal heartbeat, loss of appetite, and belly ache. Common however less-serious unwanted effects effects} include blurred or double vision; dizziness; uncontrollable movements; sleepiness; weight change; ringing in the ears; hair loss; again, stomach, or joint ache; painful menstrual intervals; confusion; diffculty speaking; and dry mouth. Antipsychotic Medication Antipsychotic medicine could also be} used to treat mania with psychosis. See the part "Medication for Schizophrenia and Other Psychotic Disorders" for detailed details about the medications. People who take antipsychotics need to have their blood cell counts, blood glucose, and ldl cholesterol monitored by a healthcare supplier.

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Scores for every of 10 items have been averaged to obtain a decisional conflict rating, with larger scores indicating more decisional conflict. Men additionally reported past experiences with prostate most cancers screening, communication with physicians, and prostate most cancers knowledge. Results: Mean age was 58 years and the majority had minimal of|no less than} some school schooling (72. These outcomes counsel that, to facilitate better choices about this controversial subject amongst black males, doctors ought to contemplate more open dialogue about prostate most cancers screening, and that they embody the risks, advantages, and controversies in their conversations with sufferers. On the idea of the social-cognitive processing mannequin, a number of} research discovered cognitive processes and emotional processes necessary mediating variables. However, no existing research have thought of trait emotional process similar to ambivalence over emotional expression as a mechanism underlying the association between social constraints and psychological misery, and little effort has been contributed to look at the interaction between cognitive and emotional processes under the influence of social constraints. The present study examined the association between social constraints and psychological misery, and the roles of ambivalence over emotional expression, avoidance and intrusive thoughts on this relation. Method: Ninety-six Chinese breast most cancers survivors aged between 37 and 77 (M = 54. Interested and eligible individuals have been invited to full a questionnaire package deal assessing their levels of social constraints, ambivalence over emotional expression, avoidance, intrusive thoughts, melancholy and posttraumatic stress symptoms. Results revealed a optimistic relationship between social constraints and psychological misery (depression and posttraumatic stress symptoms). Such relationship was mediated by ambivalence over emotional expression, avoidance and intrusive thoughts. In addition, the association between social constraints and intrusive thoughts was mediated by ambivalence over emotional expression and avoidance; the association between ambivalence over emotional and psychological misery and the association between avoidance and psychological misery have been mediated by intrusive thoughts. Discussion: Extending beyond previous analysis findings, we discovered social constraints related to larger levels of psychological misery, and such association was mediated by trait cognitive and emotional processing. Theoretical and practical implication on the development of interventions concentrating on at maladaptive cognitive and emotionally processes amongst socially constrained breast most cancers survivors might be mentioned. Prevalence estimates range barely between sexual orientation dimensions and tremendously relying on how a dimension is operationally defined. Increased physical activity and motion could help stop weight achieve; nonetheless, little is thought about the kind, intensity, or quantity of motion needed to stop weight achieve on this population. Traditional physical activity promotion programs have centered on train, which can be perceived as not fun or too stressful amongst survivors, reducing adherence and well being advantages. This pilot study investigated the influence of two non-traditional forms of train, Latin dance and tai chi, on physical activity and body composition in breast most cancers survivors in Phoenix, Arizona. Participants have been randomized to a Latin dance (N=7) or tai chi (N=6) class and have been asked to attend a one-hour class twice per week for eight weeks. Paired t-tests determined that there were no vital modifications in body mass index (T1 M=29. Activity levels elevated in each groups as participants had more steps per day at post-intervention (T1 M=6,594; T2 M=6,702); nonetheless, this was not vital. Latin dance and tai chi are engaging, culturally relevant forms of train that emphasize leisure and fun. These outcomes counsel that these activities are appropriate and may result in general increases in physical activity, help stop weight achieve and decrease body fats on this population. Research and apply ought to contemplate non-traditional forms of physical activity to accompany recovery and remedy in breast most cancers survivors. Results: Participants have been primarily female (69%), married (67%), middle aged (M = fifty seven. Survivors reported a variety of|quite a lot of|a big selection of} most cancers diagnoses, with breast (25%) and colorectal (8%) the most common. This association was stronger for survivors with less entry to offline social support. Thus, the need to keep away from out there well being information could impede protection behaviors, screening efforts, and identification of skin most cancers danger. Learning about personal skin damage threatening and prompt adverse emotions (Sweeny et al. In addition, want to keep away from personal feedback about skin damage was measured utilizing an avoidance scale. Findings counsel want to|the necessity to} tailor customized well being information in a non-threatening means for individuals who prefer to keep away from the data. Method: Spanish-speaking Latina most cancers sufferers scheduled to obtain chemotherapy and enrolled in a stress administration intervention study completed measures previous to starting chemotherapy or receiving their randomized intervention. Results: Participants have been 176 sufferers [mean age: 52 (range: 28-87); mean years lived in U. Conclusion: the current findings point out that intrusive thoughts and feelings are a typical problem amongst Spanish-speaking Latina most cancers sufferers and are related to less capability to discover that means and peace. These findings counsel that high levels of religious well-being, particularly the meaning/peace aspect, a protecting issue with respect to cancer-related intrusions in Spanish-speaking Latina most cancers sufferers. While there have been quantity of|numerous|a selection of} interventions developed for most cancers survivors, interventions that handle the quantity of} and significant psychosocial wants of ovarian most cancers survivors are restricted. The purpose of the current study was to develop and assess the feasibility of a web-based high quality of life intervention for rural ovarian most cancers survivors. Methods: Ten ovarian most cancers survivors participated in a 10-week group e-health intervention led by two psychologists. Structured interviews and weekly evaluations have been used to obtain feedback on the web site} and intervention content material. Before and after the intervention, measures of melancholy, sleep, social support, and psychological well-being have been administered. Results: Emerging qualitative themes included feedback that participants loved the opportunity to meet other ovarian most cancers survivors and the comfort of participating at home. The most common difficulties reported have been time constraints and dealing with technical issues. Conclusions: Results counsel a web-based intervention is accessible and possible with ovarian most cancers survivors in rural areas. Preliminary outcome data suggests the intervention reduces depressive symptoms and favorably impacts other features of high quality of life. The intervention has potential to serve as a mannequin for reaching rural most cancers populations and addressing psychosocial factors in ovarian most cancers survivors. [newline]Future research ought to embody randomized controlled trials with long-term follow-up. Two research examined the connection of restrictive emotionality and social constraints on depressive symptoms in two disparate samples of males with most cancers. Significant, optimistic associations have been noticed for restrictive emotionality (r=. Social constraints moderated the connection, such that high restrictive emotionality was related to greater depressive symptoms in those in excessive (B=. Social constraints moderated the connection with depressive symptoms in a unique (and opposite) pattern than evidenced in young adults. Here, low restrictive emotionality was related to greater depressive symptoms in those with relatively larger social constraints (B=-. Findings spotlight the differing relationships between restrictive emotionality and social constraints on depressive symptoms in young and older adult males with most cancers. Multivariable logistic regression was performed find a way to} see if variables have been nonetheless vital after adjusting for the opposite scales. The present study tested the hypotheses that greater endorsement of masculinity norms. Although outcomes are inconsistent with masculinity principle and prior qualitative findings, additional work is needed to decide whether or not findings generalize to other populations and settings. This age-period usually involves parenting and, as a consequence, greater than 18% of all most cancers sufferers are parenting a baby under the age of 18 on the time of analysis. To determine familybased intervention opportunities targeted to this understudied population we performed formative analysis investigating the facilitators and obstacles of profitable engagement in remedy amongst oncology sufferers parenting kids 18 years of age. Methods: Qualitative interviews and quantitative surveys have been performed with each most cancers sufferers and their spouses. Results: Qualitative interviews have been performed with 9 participants (5 sufferers, four spouses).

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Maternal and obstetric threat elements for sudden toddler death syndrome within the United States. Risk elements for sudden toddler death syndrome: adjustments associated with sleep place recommendations. Antenatal and intrapartum elements associated with sudden toddler death syndrome within the New Zealand Cot Death Study. Relationship of sudden toddler death syndrome to maternal smoking throughout and after being pregnant. Cigarette smoking as a threat factor for sudden toddler death syndrome: a populationbased study. The impact of maternal smoking throughout being pregnant on sleep respiratory and arousal patterns in neonates. Prenatal publicity to cigarette smoking is associated with a decrease in arousal in infants. Effects of maternal tobacco smoking, sleeping place, and sleep state on arousal in wholesome time period infants. The impact of maternal smoking on respiratory and arousal patterns in preterm infants throughout sleep. Deficient hypoxia awakening response in infants of smoking moms: possible relationship to sudden toddler death syndrome. Arousal and ventilatory responses to hypoxia in sleeping infants: effects of maternal smoking [published correction appears in Respir Physiol Neurobiol. Maternal smoking and increased threat of sudden toddler death syndrome: a meta-analysis. Risk of sudden toddler death syndrome amongst infants with in utero publicity to cocaine. Relationship of maternal substance abuse to subsequent sudden toddler death syndrome in offspring. Intrauterine cocaine publicity and the risk for sudden toddler death syndrome: a meta-analysis. Diphtheria-tetanus toxoidspertussis vaccination and sudden toddler deaths in Tennessee. Possible temporal association between diphtheria-tetanus toxoid-pertussis vaccination and sudden toddler death syndrome. Risk of sudden toddler death syndrome after immunization with the diphtheria-tetanuspertussis vaccine. Diphtheria-tetanus-pertussis immunization and sudden toddler death: outcomes of the National Institute of Child Health and Human Development Cooperative Epidemiological Study of Sudden Infant Death Syndrome threat elements. Sudden toddler death syndrome and diphtheria/tetanus toxoid/pertussis/ poliomyelitis immunisation. Sudden toddler death syndrome and diphtheria-tetanus-pertussispoliomyelitis vaccination status. Deaths reported to the Vaccine Adverse Event Reporting System, United States, 1997-2013. Adverse occasions following Haemophilus influenzae type b vaccines within the Vaccine Adverse Event Reporting System, 1990-2013. Sudden sudden death in infants underneath 3 months of age and vaccination status-a case-control study. Association between sudden toddler death syndrome and diphtheria-tetanuspertussis immunisation: an ecological study. Day-to-day reactogenicity and the wholesome vaccinee impact of measles-mumps-rubella vaccination. Suffocation deaths associated with use of toddler sleep positioners-United States, 19972011. Potential to prevent carbon dioxide rebreathing of business products marketed to reduce sudden toddler death syndrome threat. Prolonged apnea and the sudden toddler death syndrome: medical and laboratory observations. Sudden toddler death syndrome in infants evaluated by apnea programs in California. Are polygraphic and cardiopneumographic respiratory patterns useful tools for predicting the risk for sudden toddler death syndrome? Plagiocephaly and brachycephaly within the first two years of life: a potential cohort study. Risk elements for deformational plagiocephaly at start and at 7 weeks of age: a potential cohort study. Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly with out synostosis. Physiologic research on swaddling: an historical baby care follow, which may promote the supine place for toddler sleep. Infant deaths and injuries associated with wearable blankets, swaddle wraps, and swaddling. Influence of swaddling expertise on spontaneous arousal patterns and autonomic control in sleeping infants. Minimizing the risks of sudden toddler death syndrome: to swaddle or to not swaddle? The effects of swaddling on oxygen saturation and respiratory price of wholesome infants in Mongolia. Developmental dysplasia of the hip earlier than and after rising neighborhood consciousness of the dangerous effects of swaddling. Recent advances within the prevention, early prognosis, and treatment of congenital dislocation of the hip in Japan. The Quechua manta pouch: a caretaking follow for buffering the Peruvian toddler against the quantity of} stressors of excessive altitude. Determination of low concentrations of potentially toxic parts in human liver from newborns and infants. Incidence and geographical distribution of sudden toddler death syndrome in relation to content of nitrate in drinking water and groundwater ranges. Barriers to following the supine sleep advice amongst moms at 4 facilities for the Women, Infants, and Children Program. Maternal and toddler characteristics associated with susceptible and lateral toddler sleep positioning in Washington state, 19962002. Reducing the risk of sudden toddler death syndrome in baby care and altering provider practices: classes learned from an indication project. Changing hospital new child nursery follow: outcomes from a statewide "Back to Sleep" nurses coaching program. Usage and impact of an online schooling tool for stopping sudden sudden death in infancy. Changing nursery follow gets inner-city infants within the supine place for sleep. Effect of media protection and doctor recommendation on utilization of breast cancer screening by ladies forty years and older. Measuring Media Effectiveness: Comparing Media Contribution Throughout the Purchase Funnel. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Cancer Research Review An Overview of Recent Cancer Research Publications Featuring Illumina Technology Table of Contents Introduction. Among all these alterations are a choose few that drive the progression of the illness. Real progress in cancer research will come through the measurement and integrated evaluation of all these interdependent processes. Nat Rev Genet thirteen: 795-806 4 Cancer Biology Tumor Heterogeneity Every individual carries a novel set of inherited germline mutations. As cancer progresses, additional somatic mutations and genomic rearrangements accumulate.

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Similarly, sputum induction must be prevented because of of} increased risk of aerosolization. Tracheal aspirate specimens appear to carry a lower risk of aerosolization and might typically be obtained with out disconnecting the affected person from the ventilator. In a study of a hundred and fifty patients from 2 hospitals in Wuhan, China, shock was a major cause for demise in 40%, and may, at least of|no less than} partly, be because of of} fulminant myocarditis (46). The majority of these may be} out there report unadjusted estimates (12, forty two, 46). Despite methodological limitations, these studies recommend that older age, comorbidities (especially diabetes and heart problems together with hypertension), lower lymphocyte count, larger D-dimer level, and possibly cardiac damage are risk elements to contemplate. However, all assessed outcomes favored conservative fluid remedy (lower volumes). Importantly, the quantity and quality of evidence have been both judged to be very low, suggesting that extra analysis is needed. Considering that some colloids are harmful (see below), all colloids are extra costly than crystalloids, and availability of colloids is proscribed in some settings. However, the purpose estimates for both outcomes recommend a potential for profit from buffered crystalloid options. A systematic evaluate and meta-analysis on crystalloid versus colloid use in critically ill patients recognized 19 trials evaluating crystalloids with dextrans (n=4,736) (54). Factors figuring out the selection between vasopressin and epinephrine may include availability and contraindications to the 2 brokers. With vasopressin, digital ischemia may be be} a concern; with epinephrine, tachycardia and extra lactate production may be be} issues. In a current scientific follow guideline, the usage of} vasopressin and vasopressin analogs in critically ill adults with distributive shock was assessed (58). The presence of pre-existing comorbid circumstances such as heart problems, diabetes, persistent respiratory illness, hypertension, and cancer have been associated with larger risk of demise (12). In critically ill patients, hypoxia can be detrimental and is associated with poor outcomes (66). However, the panel used oblique evidence from the acutely ill inhabitants to inform the recommendations. If the Pplat > 30 cmH2O, Vt reduced in 1 mL/kg (to four mL/kg) steps until Pplat was within range. The risk of demise was related in both groups: 28% in the conservative fluid strategy group and 31. Prone positioning theoretically makes air flow extra homogeneous by decreasing ventral alveolar distention and dorsal alveolar collapse (111). This may reduce the distinction between the dorsal and ventral transpulmonary pressures, along with lowering lung compression (112) and improving perfusion (113). Further, proning can be carried out in low- and middle-income settings, and efforts must be made to provide the necessary coaching and schooling of healthcare staff to facilitate the follow. Practical issues: A protocol for proning must be used at all institutions, based on the out there assets and level of training. If prone air flow is used, healthcare staff should be aware of|concentrate on|pay attention to} issues such as stress sores, vascular line and endotracheal tube displacement, facial edema, transient hemodynamic instability, corneal abrasions, brachial plexus damage, and hemodialysis vascular entry flow issues. In addition, clinicians must be acquainted with the absolute contraindications for prone air flow, such as unstable spine, open abdomen or open chest. Enteral diet via nasogastric or nasoduodenal tube can be continued throughout proning (118, 119). The subgroup of studies reporting PaO2/FiO2 (mm Hg) values a lot as} 24 hours after the intervention confirmed a statistically important distinction in favor of inhaled nitric oxide, which was not present beyond 24 hours. However, in view of the discovering of improved oxygenation, a trial of inhaled nitric oxide as a "rescue" remedy, after making an attempt other choices, is cheap if out there. If inhaled nitric oxide is used and not using a|with no} good response in terms of|when it comes to|by method of} oxygenation, it must be tapered off to keep away from rebound the pulmonary vasoconstriction that can occur with extended use and abrupt discontinuation. However, exposure to excessive levels of constructive stress may result in barotrauma, nicely as|in addition to} trigger transient hypotension in already critically ill and unstable patients. However, this cohort study is at excessive risk of choice bias given its retrospective design. Therefore, its use as a rescue remedy must be reserved for rigorously selected patients (139). More evidence is needed before we will to} make recommendations on the therapy choices for cytokine storm. Although attention-grabbing, we judged these preliminary stories to be an inadequate foundation for formulating recommendations, because of of} the chance of confounding. However, these trials included different populations, the impact on mortality end result was unclear, and they used different drugs and dosing regimens. In addition, there are some considerations about corticosteroid use in viral pneumonias. There are many revealed observational studies on the usage of} steroids in viral pneumonias. We up to date a current Cochrane evaluate on the usage of} corticosteroids in influenza (144) and looked for studies on other coronaviruses. Furthermore, in both instances, the abstract statistic tended toward harm with the usage of} steroids. This suggestion is due to this fact based upon extrapolation of knowledge from other viral pneumonias, significantly influenza (154). Co-infection with Staphylococcus aureus is common with influenza pneumonia and can be particularly virulent (154). Recent scientific follow guidelines recommend initiating empiric antibacterial remedy in adults with community-acquired pneumonia who check constructive for influenza (154). Data from critically ill patients reveal secondary an infection in about 11% of instances, though the numbers are small. These infections must be treated based on scientific and microbiological data. In the most important report from China, the median temperature throughout 1,099 patients was 38. Given the safety of acetaminophen and lack of harm in the physique of evidence, growing affected person comfort via fever administration possibly important. Until extra evidence is out there, we suggest using acetaminophen/paracetamol to treat fever. However, data from current trials on the usage of} antibody-based therapies (immune plasma, hyperimmune globulin, monoclonal antibody to hemagglutinin stalk)(173) in hospitalized seasonal influenza patients did not reveal enchancment in outcomes (174-176). A appreciable number of brokers accredited for other indications have been proposed for use, however the feedback beneath tackle essentially the most promising ones. The drug has a typically good security profile, however may have interactions with many drugs generally utilized in critically ill patients. The trial was unblinded and it enrolled a small number of patients (n=199) with a small number of events (44 deaths in total), which limits our confidence in its results. A current consensus document beneficial chloroquine phosphate 500 mg twice day by day for minimal of 5 days, with dose modifications if severe gastrointestinal facet effects occur (213). A current study in China explored various dosing regimens of chloroquine and hydroxychloroquine using physiologically-based pharmacokinetic fashions (209). Based on these fashions, a hydroxychloroquine loading dose of four hundred mg twice day by day followed by 200 mg twice day by day for four days was beneficial (209). Pending the results of ongoing trials, we have been unable to problem a suggestion for or against chloroquine. Nitazoxanide is an antiprotozoal agent with antiviral potential against several of} respiratory viruses together with influenza, parainfluenza, respiratory syncytial virus, and rhinovirus. However, in hospitalized patients with severe acute respiratory an infection in Mexico, nitazoxanide was not discovered to be superior to placebo (223). Zainab Al duhailib, Kimberly Lewis, Malik Farooqi, and Jessica Batoszko for their help with conducting systematic reviews and meta-analyses for guideline questions. Maurizio Cecconi declared consultancy work with Edwards Lifesciences, Directed Systems, and Cheetah Medical. Strength Best follow assertion 2 3 Best follow assertion Weak four Weak 5 Weak Best follow assertion 6 7. Remark: A typical corticosteroid routine in septic shock is intravenous hydrocortisone 200 mg per day administered either as an infusion or intermittent doses. Weak Weak Weak Weak Weak Weak Weak Strong Weak Weak Weak forty three Remark: the majority of our panel help a weak suggestion. However, due to the very low-quality evidence, some specialists on the panel most popular not to problem a suggestion until larger quality direct evidence is out there.

Disodium Phosphate (Phosphate Salts). Plavix.

• Low blood phosphate, when sodium and potassium phosphates are used.
• Improving aerobic exercise performance.
• Dosing considerations for Phosphate Salts.
• Sensitive teeth, heartburn, cleaning out the bowels as a laxative preparation for intestinal tests such as colonoscopy when sodium phosphates are used, and other conditions.
• Are there any interactions with medications?
• High blood calcium, when sodium and potassium phosphates are used.

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Weeks 1-2 had been used as a baseline measure of steps, and Weeks 3-12 as intervention. Location and calendar data (busy/free) was collected along with a battery of psychometric measures such as self-efficacy, consequence expectations, perceived stress, barriers/facilitators of bodily activity, and quality of sleep through ecological momentary assessment. Conclusion: Overall, outcomes suggest good adherence to the intervention, and acceptable data for building a dynamical model. Lack of success in weight loss programs can be attributed to lack of adherence to dietary suggestions, i. Lapses have been linked to a choose group of internal and external cues, suggesting that lapse prediction andprevention are potential, given adequate data. We will describe our theoretical rationale; our 4 phases of growth; metrics and strategies used to successively improve the system; and our multidisciplinary staff structure (psychologists, biostatisticians, pc programmers, web developers, and graphic designers). Participants used DietAlert to enter the presence/absence of potential lapse triggers and lapses 6 occasions per day for six weeks. Currently 159 pairs of 6-20-sentence interactive interventions have been developed. Clarity, satisfaction and effectiveness of the interventioncapable app shall be offered. Overall, outcomes shall be used to evaluate the strengths and weaknesses of our growth process and to touch upon the potential of DietAlert and similar methods to meaningfully improve weight loss outcomes. Angela Pfammatter, PhD Excess energy consumption and poor quality diet are main contributors to chronic illnesses including obesity, diabetes, and heart problems. However intervening to improve consuming self-regulation has been impeded by a reliance upon self-report as the first technique of consuming assessment. Diet diaries, 24-hour recall, photographic recording of foods, and ecological momentary assessments are prone to measurement unreliability because of of} errors of omission and biased reporting. These strategies are also highly burdensome and largely generate personalized behavioral data after the actual fact}, i. Technological advances in wi-fi communication, inertial sensors, automated image recognition, smartphones, and wearable devices enable continuous in-field passive sensing of behavior that can pave greatest way|the way in which} towards of|in direction of} real-time, dynamic, personalized, preventive behavioral intervention. Achieving this vision requires collaboration between pc scientists, engineers, and behavioral scientists who make use of totally different methodologies. This presentation will current an in-process case study that illustrates the appliance of pc science strategies to the sequential problems of consuming detection, consuming prediction, and consuming intervention. The presenters will use data from research utilizing a Pebble Watch, Microsoft Wristband, and neckworn digicam to capture consuming ground truth to reveal the appliance of machine studying strategies first to detect consuming in real time, after which to develop algorithms that predict consuming via the identification of consuming triggers. Background: the American Heart Association now endorses depression as a danger issue for poor prognosis in cardiac sufferers. Participants completed self-report measures related to depression, anxiousness and unfavorable result on}. It supplies preliminary support for the utility of dimensional fashions may be} data-driven and person-centered. Methods: Data from the Geelong Osteoporosis Study comprising an agestratified, population-based sample of girls (aged 20-94 years) had been utilized (n=859). Of the seventy three prevention research, 31 focused pediatric (43%) and forty two focused adult populations (58%). Targeted behaviors included sunscreen (n=64), protective clothes (n =49), hat (n =48), shade (n =38), noon sun avoidance (n =27), sunglasses (n =21), sunbathing avoidance (n =15), indoor tanning avoidance (n =12), and minimizing incidental sun publicity (n =10). Of the 33 research (45%) that included a composite behavior score, most (n =27) achieved a major enchancment (as reported by the authors). A breadth of interventions focused on skin most cancers prevention and screening, with far more focused on single website interventions than on dissemination or neighborhood settings. We talk about essential intervention qualities, opportunities to improve study methodology, and implications for intervention growth and translational research to inform the field. A similar rubric has proved useful in furthering other behavioral intervention research. The session will convey outcomes and foster dialogue of research needs and methodological considerations specific to behavioral researchers. Descriptive data, derived from use of a structured coding protocol, characterizing the published literature with respect to intervention efficacy and the character of dissemination research are offered. Presentation-2 supplies data concerning methodology with respect to use of principle, know-how, coverage, and environmental manipulation underpinning the literature summarized in Presentation1. Method: the analysis included grants between 2000-2014 that used observational or interventional designs and focused well being behaviors or examined behavior intervention effect on cancer-relevant outcomes alongside the most cancers continuum. Following established portfolio analysis procedures, we established coding criteria and choice rules, trained coders, and scored every grant by independent coders. Along the translational research continuum, there have been 14 T-1, 10 T-2, and seven T3/T4 intervention initiatives. We recognized 87 articles that met inclusion criteria of being published from 2000-2015 in peer reviewed journals, having a randomized managed or quasi-experimental design, and concentrating on behavioral intervention in skin most cancers. Of the remaining 80 articles, 60 focused on selling main prevention behaviors. Of the 80 prevention and screening research, most used some sort of know-how (67. Women expertise an alarming rate of high-risk pregnancies including pregnancies difficult by gestational diabetes mellitus. The research staff completed a three-hour on-site training session to hospital/center personnel and distributed research toolkits in English and Spanish. Findings from the well being assessment suggest that ladies are thinking about participating in a well being promotion program that starts during being pregnant and continues after birth. Program elements ladies had been mostly thinking about are diet, exercise, breastfeeding support, and social support. The purpose of this symposium is to discover potential obstacles to positive being pregnant and birth outcomes as properly as their effect on youngster growth. Lisette Jacobson will current findings of a multi-partner well being collaborative to improve being pregnant and birth outcomes among reproductive-age ladies in an extremely underserved frontier rural region. Michelle Redmond will current study findings on the perceived dangers and challenges to sustaining recommended ranges of prenatal bodily activity and wholesome dietary habits during being pregnant. Layla Esposito will synthesize study outcomes and advocate elements for future interventions that promote wholesome behaviors among reproductive-age ladies. This purpose of this speak shall be to 1) summarize current literature analyzing the role of prenatal obesity and gestational weight gain on youngster neurodevelopmental outcomes and 2) current data from our ongoing community-based birth cohort. Pregnant ladies had been recruited from regional prenatal clinics from April 2005 to June 2011 (n=2,667). Compared to recommended gestational weight gain, each lower than and higher than recommended gestational weight gain was associated with poorer functioning related to Attention Problems (B = 1. The outcomes align with a growing physique of literature indicating that maternal obesity and excess gestational weight gain harm optimal neurodevelopment in children. The direction of future observational, mechanistic and intervention research on this space shall be discussed. C O R R E S P O N D I N G A U T H O R S: L i n Wa n g, P h D, D u k e U n i v e r s i t y; lin. Michelle Redmond, PhD Objective Moderate bodily activity during uncomplicated pregnancies helps a more healthful intrauterine setting for the fetus and higher being pregnant and postpartum outcomes for the mother. Exercise considered one of the|is among the|is probably certainly one of the} few therapeutic interventions out there to assist make being pregnant less obesity-inducing. This study will discover perceived challenges to sustaining recommended ranges of prenatal bodily activity and wholesome consuming habits during being pregnant. Design: A Prospective cohort study was performed to exmaine/identify the fears and obstacles to prenatal exercise. Participants: Ninety females with a singleton being pregnant between sixteen to 30 weeks gestation had been enrolled within the study. Main Outcome Measures: Our main consequence is obstacles to bodily activity and wholesome consuming. Results: Preliminary outcomes indicate ladies who maintained at least of|no less than} ninety minutes or more per week of moderate bodily activity during being pregnant had been more proceed to exercise despite bodily feeling tired X2(1, N = 90) = 5.

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Increase in number of days of intense exercise was associated with improved general coping methods (=0. Increasing ordinary every day actions was associated with improved diversion coping methods (=0. Additionally, ensuring opportunities for sports group participation for all youth could also be} an essential half of} weight problems prevention efforts. Dog ownership rates in the United States and Canada are roughly 40% and 34%, respectively. There has but to be a research that examines the associations of canine ownership and physical exercise among most cancers survivors. Conclusions: We discovered the ownership rate among this pattern of most cancers survivors was less than the national averages beforehand reported in the literature (25% vs. Results among most cancers survivors are just like previous research in other populations. Among minority populations, solely 5% of non-Hispanic Black older adults met the guidelines comparability with} 12% of non-Hispanic Whites. It is suggested recommended|is recommended} that much of the problem encountered in selling physical exercise inside African American city communities appears to outcome from a limited understanding of psychosocial components which impact the adoption and upkeep of physical exercise packages. Questions posed to each focus group focused participant limitations towards physical exercise properly as|in addition to} motivators and preferences of physical exercise. The most distinguished motivator of physical exercise among the participants was the provision of group actions. Sixteen of the twenty-one participants most well-liked exercising in group or with a companion and agreed that social help was crucial to them. These findings spotlight distinctive challenges that have to be addressed when implementing physical exercise packages for African American populations in city communities. Future research and outreach ought to contain development of group based physical exercise interventions with a strong emphasis on social help to promote a wholesome active lifestyle among African American older adults. Participants described more execs than cons to physical exercise (based on decisional steadiness scores >0, M=2. Baseline knowledge affirm that the pattern is in want of intervention excessive rates of weight problems and low ranges of physical exercise. Moreover, scores on psychosocial measures suggest that such efforts could also be} well obtained. This line of research in low price, excessive attain technology-based approaches selling physical exercise in African American women in the Deep South has great potential to tackle well being disparities and impact public well being. Methods: the Brain Blasters pilot was developed based on suggestions from teachers in five faculty districts. After the completion teachers (n=16) were requested to participate in a six-question survey. Results: Overall, follow-up survey results indicated most teachers discovered at least of|no less than} one method of supply useful. Importantly, teachers in one faculty reported the videos were most useful while teachers in the other faculty differed between videos, e-mails, and mailbox assets. A third of teachers said time inhibited their capacity to view and/or make the most of the supplies. School personnel inside a particular faculty must be consulted when figuring out the best method(s) for delivering assets inside that college. Participants and Methods: Older adults were recruited at quantity of} sites to exercise using virtual reality enhanced stationary bikes. Participants accomplished cognitive checks earlier than and after a single bout and three months of exercise. Tests of executive perform were administered pre- and post-exercise: Color Trails, Stroop & Digit Span. It could also be} that this biomarker indicates the standing of neurobiological substrate and processes, which is indicative of readiness to profit from the link between physiological exercise and cognitive outcomes. Method: Participants were 228 adult canine homeowners who accomplished a web-based survey that included demographics, canine walking, canine responsibility/attachment and exercise rules. Conclusion: A sense of responsibility to walk the canine, typically the most dependable correlate in previous canine walking research, appears to align with more selfdetermined forms of motivation than controlled. The findings, nevertheless, help the premise that canine walking conduct could also be} a posh mix of human and dog-related components. This canine and proprietor relationship may need consideration for profitable future canine walking promotion initiatives. Methods: forty eight Latinos (45 feminine & three male) and63 African Americans (40 feminine & 23 male) participated in focus teams (n=12). Results: Both Latinos and African Americans described active dwelling as transferring, working and exercising. African Americans included working in the community and taking medicines and Latinos mentioned walking and never sitting as active dwelling. Common limitations to active dwelling expressed by both teams were laziness, lack of schooling, time, and transportation; while African Americans recognized cultural habits, lack of help networks, costs, limited packages, and safety and Latinos mentioned lack of motivations and language as limitations to active dwelling. African Americans discussed senior facilities, Girls and Boys Clubs and Latinos mentioned hospitals and the Latin American Community Center. Activities that both teams would take pleasure in include walking, running, and outdoor sports; dancing and group actions were discussed in African Americans and going to the park was one thing Latinos would take pleasure in. Conclusion: Program planning to enhance active dwelling in these populations in Delaware ought to tackle the limitations derived from primary target|the main focus} group particular to each inhabitants. The purpose of the current research was to study the cross-sectional and potential relationships between different coping types with alcohol use and exercise. We hypothesized that stronger endorsements of more optimistic coping types would predict larger exercise while stronger endorsements of more negative coping methods would predict larger alcohol use. In an on-going research, participants (N=75) reported their common ingesting and exercise conduct at a baseline (T1) and two-week follow-up (T2) session. Based on the cross-sectionaloutcomes at T1, we computed impartial regressions predicting exercise and alcohol use over the previous week at T2. Thus, excessive scores on more negative coping types could also be} indicative of elevated ingesting while excessive scores on more optimistic coping types could also be} indicative of larger exercise. Although these knowledge are correlational, these outcomes might have implications for enhancing particular coping types so as to to} encourage more wholesome behaviors. Methods: We conducted focus teams with obese or overweight Mexican/Mexican-American females (N=13), ages of 27-40 years. Compliance was defined because the percent of the three cardio and two resistance coaching sessions attended per week. Adherence was defined because the percent of the required a hundred and fifty minutes of cardio exercise and 2 of|and a pair of} units of 9 resistance coaching workouts performed each week. The compliance with the cardio and resistance coaching prescriptions were 77% and 79%, respectively. These findings demonstrate that an exercise coaching intervention (distinguished from group based behavioral intervention) in African American males may be successfully carried out in the community, offering a generalizable mannequin. Research Method/Design: 350 males and girls with back ache were categorized as actors (n = 150), intenders (n = 111), and non-intenders (n = 89). Non-intenders have decrease outcome expectancies than both actors and intenders (p <. Actors understand themselves to be at less danger than both intenders and non-intenders (p =. Actors spend more time in vigorous, reasonable, and light physical exercise than both intenders and non-intenders (p <. Actors also spend less time in sedentary conduct than both intenders and non-intenders (p p =. Conclusions/Implications: There are differences in social-cognitions, physical exercise participation, and back pain-related variables between actors, intenders, and non-intenders. Method: Participants included 714 fourth-graders from 9 central Texas schools (m age=9. Conclusion: In order for young students to obtain cognitive and educational benefits from interventions involving physically active, educational classes, it might be necessary to guarantee a reasonable intensity.

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To accomplish this, a better understanding of the molecular-, cellular-, and tissue-level communication networks that drive the most important transitions in cancer from (1) normal cells to (2) dysplasia to (3) in situ carcinoma (noninvasive tumors) to (4) invasive illness and (5) metastasis is needed. This have to be integrated with in-depth information on how tumors (6) respond to therapy and (7) develop drug resistance. Tumor Microenvironment parts Primary Tumor Tumor Microenvironment Dendritic Cell Natural Killer Cell Macrophage Cell Fibroblast T Cell Regulatory T Cell Myeloid Cell Blood Vessels 33 18 Multilevel Network Analyses & Data Integration Human tumor atlases will present the tissue, tumor, cell, and molecular degree interactions of cancer. Computer modeling and information integration of this multilevel data will enable for the creation of dynamic visible assets of tumor evolution. The organ- and tissue-level communication networks that assist tumor growth, growth, and metastasis can be mapped and integrated with analyses at quantity of} ranges. Cancer growth, progression, and metastasis require complicated interactions inside the local tumor microenvironment that are be} mediated by many elements. The emergence of highly effective new applied sciences and computational methods has put a complete understanding of tumor ecosystems inside our reach. These intracellular networks can be mapped in all cells within the tumor microenvironment for integration into an atlas. Cancer cells have genetic and epigenetic alterations that influence the group and expression of genes. These alterations and their effects on cancer cells can be mapped and integrated with other-level analyses in a tumor atlas. As a measure of its significance, cancer prevention has the potential, in lengthy run|the long term}, to save even more lives than therapy. Effective prevention may even scale back cancer incidence and morbidity, that means fewer individuals will have to face the physical, financial, social, and psychological harms of a cancer prognosis and therapy. One approach to cancer prevention is reducing or eliminating exposures to cancer-causing substances within the setting, corresponding to asbestos, tobacco smoke, and radon gasoline. Another approach is to protect the body in opposition to such exposures or scale back their effect. In addition, some cancer screening checks, such because the Pap smear for cervical cancer and colonoscopy for colorectal cancer, can aid in cancer prevention. These checks detect premalignant lesions that may be} eliminated or destroyed earlier than they progress to cancer. Reasearch within the subject of cancer prevention is usually not feasible within the non-public sector end result of} the numerous economic, logistical, and scientific challenges that have to be overcome. No one knew why the risk of this cancer was so high in his family or how to to|tips on how to} prevent it. They used the Utah Population Database to hint the mutated gene to a family that had settled there within the 1850s. Approach · Identify and research threat elements for cancer, including personal and environmental threat elements. In a mouse mannequin in which the mutant protein can be activated, administering the vaccine earlier than activating the mutant protein reduced both the number of lung tumors that fashioned and tumor dimension by greater than 80% with out opposed effects. How the Swallowable Balloon Device Helps Detect Barrett Esophagus Swallow Inflate & Collect Retrieve Instead of undergoing standard endoscopy, patients can swallow a pill-sized capsule attached to a skinny silicone catheter. The balloon is deflated through the catheter and inverted again into the capsule, thus defending the pattern from dilution or contamination. The small dimensions of the balloon system enable clinicians to retrieve samples quickly and simply with out sedation during an outpatient exam. Opportunities for Greater Progress Thanks to basic analysis, our understanding of how cancers develop continues to grow. This increasing information, along with the provision of highly effective new applied sciences, is affording new alternatives to enhance and expand our capability to prevent cancer. In addition to developing new methods of cancer prevention, we should overcome the obstacles to implementing established approaches, corresponding to the use of of} accredited cervical and colorectal cancer screening checks and preventive vaccines, notably in populations where they traditionally have been underutilized. Increasing information, along with the provision of highly effective new applied sciences, is affording new alternatives to prevent cancer. Understanding the Biology of Precancerous Lesions and their Progression to Cancer Fully understanding the events that underlie the development of precancerous tissue adjustments and drive the transition to malignant illness will provide new alternatives for cancer prevention. This information may even lead to the identification of molecular markers that will be useful in cancer threat assessment and early detection. These analysis facilities will systematically collect, catalogue, and comprehensively analyze massive numbers of precancerous lesions and early cancers, including their microenvironments, which have developed at particular organ websites. This information may even lead to extra precise assessments of cancer threat, allowing individuals at increased threat of cancer to receive probably the most acceptable medical care to handle their threat. To scale back the incidence of those cancers, we should find revolutionary ways to assist individuals change their behaviors and make wholesome lifestyle decisions. In addition, remedies for early cancer are sometimes less complicated than remedies for more-advanced illness, sparing patients and their families higher hardship. However, too many cancers are still identified at late stages, when effective therapy and long-term survival in all probability not|will not be} potential. Another promise of early detection is the identification of precancerous tissue abnormalities that are be} destined to turn out to be life-threatening cancers, providing a chance for even earlier intervention to prevent cancer from developing altogether. Two main targets of this analysis are increasing the dissemination of proven methods of detection and prognosis and developing new and improved methods that are be} extra correct and of higher worth clinically than these available today. Another goal is to produce applied sciences and checks that are be} environment friendly and costeffective and that can be utilized in all resource Detecting Cancer Early in Women with Dense Breasts When Kristin realized she had breast cancer, her heart sank with concept that|the concept|the concept that} her quantity was up. After 20 years of work at the Mayo Clinic and because of|as a outcome of} the} widow of a Mayo researcher, Kristin was no stranger to cancer and disease-from both the analysis and scientific sides. Refining the Liquid Biopsy Vision Fewer individuals will endure and die from cancer ready to} detect and diagnose its precursors or the illness itself at the earliest potential stage. The conclusive identification of circulating tumor cells in the blood of patients with cancer greater than 60 years ago forecasted the development of the liquid biopsy. Advances in biomedical know-how are now are|are actually} bringing the promise of the liquid biopsy for early cancer detection closer to the clinic. In a retrospective evaluation, when this test was applied to blood samples from 1,005 patients with eight varieties of|several types of|various sorts of} nonmetastatic cancer, the presence of cancer was appropriately identified 70% of the time. For five of the eight cancer types for which no screening checks are currently available (ovary, liver, abdomen, pancreas, and esophagus), the sensitivity of detecting cancer ranged from 69% (esophageal cancer) to 98% (ovarian cancer). Improving Prostate Cancer Diagnosis the routine collection of prostate tissue through the rectum (prostate biopsy) has led to the increased detection of low-grade cancers, which may not need therapy, and a rise in biopsyrelated, probably life-threatening bacterial infections. Reducing the biopsy rate for men who finally show to have benign situations or lowgrade cancer would subsequently be desirable. Enhancing Cancer Detection in Dense Breasts the ability of mammography to detect breast cancer in ladies with dense breasts, which have considerably extra glandular and connective tissue than fatty tissue, is decrease than that for ladies with predominantly fatty breasts. Therefore, new know-how is needed to enhance breast cancer detection in ladies with dense breasts. Opportunities for Greater Progress Improvements in genomic, proteomic, and imaging applied sciences are presenting new alternatives for main progress in cancer detection and prognosis. These advances have the potential to enhance our capability to establish and characterize tumor cells and other biomarkers in bodily fluids and are enabling extra precise imaging. Accelerating Cervical Cancer Control A long-standing problem in reducing the incidence and mortality of cervical cancer is how to to|tips on how to} make effective cervical screening available in areas or international locations which have limited well being care assets. Another problem is how to to|tips on how to} keep away from unnecessary follow-up procedures in screened ladies with precancerous cervical tissue abnormalities which have a low threat of progressing to cancer. This approach ought to finally be adaptable for widespread use, including in areas and international locations which have limited access to professional medical services. The researchers are additionally investigating the inclusion of particular biomarkers of their triage protocol to further enhance its efficiency. There is a crucial need for added biomarkers to optimize the care of patients with cancer and at-risk people. Identifying and Validating Biomarkers for Early Cancer Detection and Diagnosis Recent advances in identifying biomarkers have improved early cancer detection and prognosis. For example, the Consortium for Molecular Characterization of Screen-Detected Lesions, currently led by investigators at eight institutions, supports analysis on the molecular and cellular options of precancers and early cancers detected through screening checks. Another program is the Alliance of Glycobiologists for Detection of Cancer, which supports eight laboratories conducting analysis on the cancerrelated adjustments in complicated carbohydrates (sugars) in cells to establish and validate biomarkers for early cancer detection. A third program is the Early Detection Research Network, a public­private partnership that provides infrastructure and assets important to the discovery, growth, and validation of cancerrelated biomarkers. Each of those methods, nevertheless, has limitations, and ongoing analysis is investigating ways to enhance their utility or develop totally new applied sciences for cancer detection. Ongoing analysis is investigating ways to develop totally new applied sciences for cancer detection. One newer approach, known as digital tomosynthesis, allows third-dimensional pictures to be constructed from quantity of} x-rays taken at totally different angles.

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The questions of drug high quality, drug cost, drug choice and eectiveness, and proper drug utilization have turn into a matter of widespread public curiosity. It is thus crucial for pharmacists to be highly educated concerning all elements of drug product high quality and optimum drug utilization on a person affected person basis. Fortunately, the pharmacist is probably the most educated professional on out there medication and drug products and criteria aecting drug product high quality. Pharmacists are additionally better qualied and extra educated than other well being care professionals when it comes to of|in relation to} drug product forms out there, relative merits of dierent dosage forms, even inside a given route of administration, and attainable or most probably aspect eects inside a given population group similar to kids or the aged. History and Evolution of Drugs and Drug Products Every pharmacist and pharmacy student should read one of many many out there books on the historical past of medication and the drug business [10±14]. A pictorial historical past similar to Drugs [10] in the Life Science Library Series or one of many several of} illustrated books on the patent remedy period [11,12] is entertaining nicely as|in addition to} academic reading. Several pharmacy trade associations have written attention-grabbing histories directed to pharmacy follow [18,19]. These references are only a few of the numerous attention-grabbing historic books on pharmacy that could possibly be} cited. When the historical past of medication and drug products is expressed as a time continuum, as shown in Table four, it is very obvious that most all} drug and drug product developments have occurred over the last 50 years. Before the early twentieth century, the one puried organic chemical substances used in chemotherapy have been aspirin, quinine, and morphine. Early Egyptian physicians recorded over 70 ``drugs' in 800 remedies administered in 14 dierent forms from tablets to ointments and salves and poultices. The medication have been all from pure sources, ranging from spider webs, to animal excretions, to packs of mud, to poppy seeds. Between the eighth and thirteenth centuries, Arabic alchemists tremendously superior pharmaceutical artwork by Copyright © 2002 Marcel Dekker, Inc. Periods and Notable Events in the History of the Development of Drugs and Drug Products First drug data Ancient to medieval pharmacy and medicine Witch doctors Religious healers Natural products growth First compendium (U. Monoclonal antibodies Nucleotide blockage Growth in use of pure products and neutraceuticals Pharmaceutical company megamergers continue Sequencing of the human gerome Gene remedy creating Use of human tissues in medicine High throughput screening of potential medication Combinatorial chemistry, biotechnology, and computers advance rational drug design Ancient times to Middle Ages 1700 1800 1850 1900 1906 1938 1945±1965 1962 Patent remedy period Golden age of discovery New regulations 1977 Nineteen Eighties Pharmaceutics advances 1980s±2000s Biotechnology period starting 2000 introducing extraction and distillation processes to concentrate and purify pure products. Pharmaceutical artwork in colonial America some 200 years in the past was little better than that of the Arabic alchemists one thousand years earlier. The patent remedy period that Їourished in the second half of the nineteenth century was a colourful interval in pharmaceutical historical past when ``curealls' have been marketed by pitchmen from the backs of horse-drawn wagons, usually as a follow-up to some free leisure used to gather the locals. As depicted in the advertised indications from the label of one popular patent remedy of the day. Grandmother Pinkham used footage of her grandchildren on her advertising and label copy; others, such as the medicinal syrups millionaire G. Green, positioned on their advertising and labeling illustrations of the mansions that their high-prot ``cure-alls' introduced them. It is attention-grabbing to speculate on the variety of individuals in the temperance period who kept all these around them ``dry' after which loved their night toddy of Lydia Pinkhams or stronger higher proof products before retiring. The Food, Drug, and Cosmetic Act of 1906 was intended to combat the abuses of the patent remedy period, at least of|no less than} partly by requiring labeling of the energetic ingredients contained in all prescribed drugs and by broadly limiting fraudulent practices. The 1938 act went additional, requiring that at least of|no less than} some principles of rational therapeutics be utilized to all products and their claims. Drug and drug product developments during the last 50±60 years have surpassed the total advancement in the eld over the entire 4000-year historical past of drug growth (see Chapter 28). The addition of some bodily tests, similar to weight variation and disintegration time to compendial products similar to tablets and capsules, was thought to accurately dene the quality of these products. We now know that drug products require very careful evaluation to accurately reЇect their high quality and efficiency in medical roles and that earlier concepts of evaluation required enlargement. The designation ``quality,' utilized to a drug product, according to a contemporary denition, requires that the product: Contain the quantity of each energetic ingredient claimed on its label, within the relevant limits of its specications Contain the same quantity|the same amount|an equivalent quantity} of energetic ingredient from one dosage unit to the following Be free from extraneous substances Maintain its potency, therapeutic availability, and look till used Upon administration, release the energetic ingredient for full organic availability In the contemporary denition of high quality we see that the concepts of id, potency, and purity are retained in the rst three criteria, however that bioavailability potency upkeep (including upkeep of pharmaceutical class and therapeutic availability or full organic availability) are added. The denition acknowledges that drug products may bear modifications with time that end in a lack of organic and therapeutic activity, despite the fact fact} that|although} the product complies completely with the unique potency and purity requirements and no signicant drug decomposition has occurred. Such losses in therapeutic activity, without any chemical potency change, may happen as a result of|because of|on account of} a variety of|quite a lot of|a wide selection of} causes, together with: Physical modifications in the dosage kind (moisture loss or gain, crystal modifications in excipients, tablet hardening, lack of disintegration=deaggregation properties, etc. Physical modifications in the drug (conversion of a extra stable, less readily soluble polymorph, etc. Chemical modifications or interactions involving excipients (such as esterication of coatings, rendering them less polar and less soluble) As noted in chapters that comply with, in vitro tests may not themselves be sufficient to guarantee that a product possesses sufficient or full bioavailability and 1. Whether or not in vitro tests are sufficient quality-control indications is dependent upon by} their sensitivity to pick-up getting older or environmental exposure eects that produce sort of|the sort of} modifications noted in the previous paragraphs or other modifications may be} of consequence to remedy. The eects of such stress conditions on bioavailability or therapeutic activity are a lot less well-known at present, even commercial products. A drug product can be of no higher high quality than the quality of the drug(s) and excipients (nondrug additives) from which the product is made. It is feasible, nevertheless, for a product to be of a lot decrease high quality than its elements, since high quality and medical efficiency are additionally related to: 1. In-process and nal quality-control procedures to guarantee that the quality designed and manufactured into the product is definitely there four. Reasonable comfort and ease of product use to guarantee affected person compliance with prescribed dosages Some of the components and issues in the design of high-quality drug products are shown in Table 5. Various physicochemical and pharmacokinetic properties of medication that aect dosage kind design, and their inЇuence on design of high-quality products, are de- Table 5 Factors in the Design and Production of High-Quality Drug Products Output components Effectiveness Safety Reliability Stability Physical Chemical Microbiological Bioavailability Pharmaceutical Appearance Organoleptic properties Input components A sound development=design manufacturing base the preformulation research database Physicochemical properties of the drug Pharmacokinetic characterization of the drug A rational dosage kind design Formulation of a stable, dependable system Objective preclinical and medical testing A exact, reproducible manufacturing course of Well-controlled manufacturing steps Coordinated manufacturing sequences Efficient, sanitary operation Modern plant and equipment Knowledgeable, well-qualified staff A delicate product management system Raw materials management Processing controls Final product controls Chemical management requirements Physical properties requirements Biological and microbiological requirements Informed, certified, and responsible personnel Management Research and growth Quality management Production Services Convenience Ease of use Dosing frequency Consumer acceptance Copyright © 2002 Marcel Dekker, Inc. The criteria and properties dening the quality of various dosage forms are mentioned in the relevant chapters on dosage forms. The features of an optimized drug are mentioned in the relevant chapters on dosage forms. The features of an optimized drug product and the concepts of true drug-delivery methods are described in the next section. Drug Products, Drug-Delivery Systems, and Therapeutic Systems Drug substances in their puried state often exist as crystalline or amorphous powders or as viscous liquids. The majority of drug substances exist as white or light-colored crystalline powders. Although medication have been as soon as} generally dispensed as such in powder papers, this follow is nearly unknown in pharmacy follow at present. With the attainable exception of the anesthetic gases, all medication in legitimate commerce at the moment are|are actually} presented to the affected person as drug products. The precise efficiency of many medication in medical follow is now recognized to be tremendously aected by the tactic of presentation of the drug to the affected person. Factors aecting the presentation embody: the portal of drug entry the bodily type of the drug product the design and formulation of the product the tactic of manufacture of the drug product Various physicochemical properties of the drug and excipients Physicochemical properties of the drug product Control and upkeep of the placement of the drug product at the absorption site(s) Control of the discharge rate of the drug from the drug product In the late Forties and early Fifties, sustained-release products appeared as a significant new class of pharmaceutical product, during which product design was intended to modify and enhance drug efficiency, by growing the duration of drug motion and decreasing the required frequency of dosing. In the mid- to late 1960s, the time period ``controlled drug delivery' got here into being to describe new concepts of dosage kind design, which additionally often concerned controlling and retarding drug dissolution from the dosage kind, however with additional or alternative aims to sustained drug motion. These new aims included bettering security, enhancing bioavailability, bettering drug eciency and eectiveness, enhancing reliability of efficiency, decreasing aspect eects, facilitating affected person use and compliance, or other benecial eects. In the Nineteen Seventies, one more time period and idea of drug product design and administration appeared: the therapeutic system. The objective of the therapeutic system is to optimize drug remedy by design of a product that includes a sophisticated engineering methods management method. Before the sustained-release concepts of the Forties and Fifties, which additionally included depot forms of parenteral products, no signicant new oral drug-delivery concepts had occurred in the previous seventy five years (since the enteric-coating concept). The Concept of the Optimized Drug Product the optimized drug product seen as a drugdelivery system for the one or more of} medication that it incorporates. The goal of this drug-delivery system is to release the drug(s) to produce the utmost simultaneous security, eectiveness, and reliability, as depicted in. Various physicochemical product properties that inЇuence the quality features of security, eectiveness, and reliability are shown in Table 6. Some physicochemical properties can aect two or all three high quality features of. If the decomposition products are toxic or irritating to the body, product security lowered as the product degrades. In inspecting Table 6, the manner during which every physicochemical, physiological, or therapeutic property aects the various high quality features will usually be obvious.

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Under special circumstances for which the rst-pass organ is the most important metabolizing organ, some simplied ideas could be established. If the rst-pass organ is dierent from the most important eliminating organ, the extraction ratio in these organs could also be} dierent, and their dependence on binding may dier. Changes in tissue binding have eects only on the tissue distribution and never on clearance. The period of this change will depend upon the half-life of the drug, which will be altered according to Eq. Drug ecacy could be improved, and drug toxicity probably decreased, if the drug could be administered on to its web site of action. However, a number of} elements stop direct software of medicine to the location of action, including incomplete data about the action web site and also poor affected person adherence owing to the inconvenience of utilizing direct software formulations. Because of those elements, most drug products have been formulated as oral, solid dosage varieties. Drugs which might be} quickly cleared by hepatic processes will present a decreased extent of availability following oral administration owing to metabolism of the drug on its rst move by way of the liver. The magnitude of this rst-pass eect will depend upon the blood Їow to the liver and the intrinsic clearing ability of the liver. This rst-pass elimination by metabolic or biliary excretion processes could be excluded if the drug is absorbed from a sublingual web site. The rectal administration of medicine eliminates approximately one-half the rst-pass metabolism. Absorption by way of nasal, dermal, and different sites may give rise to lower rstpass elimination and higher bioavailability than oral administration if the metabolic capacity of those sites for the drug in query is small. Drug distribution in the affected person will depend upon the blood blow to numerous sites in the physique nicely as|in addition to} on the partition coecient of the drug between the blood and distributive organs. Protein binding, both in the blood and in the tissues, will markedly aect this distribution. However, free drug concentrations are generally believed to be the eective determinant in drug remedy. Often a redistribution owing to adjustments in protein binding will have little eect on the therapeutic ecacy, since, although complete drug distribution adjustments, the average unbound concentrations at steady state in blood remain basically similar. An understanding of the eects of the route of administration nicely as|in addition to} the distribution of the drug within the physique is critical to the pharmacist in planning acceptable drug dosage regimens. The clearance, the opposite hand|however|then again}, is aected only by adjustments in binding in blood and will change as described in Sec. However, outcome of|as a outcome of} the unbound fraction in plasma is increased (decreased), the unbound concentration will be increased (decreased), the unbound concentration initially reaching the goal tissue will be larger (lower), and the preliminary pharmacological exercise will be larger Copyright © 2002 Marcel Dekker, Inc. Benet, Input elements as determinants of drug exercise: route, dose, dosage routine, and the drug supply system, in Principles and Techniques of Human Research and Therapeutics, Vol. Gram, the metabolism of xenobiotics by the mammalian lung, in Extrahepatic Metabolism of Drugs and Other Foreign Compounds (T. Vane, the position of the lungs in the metabolism of vasoactive substances, in Pharmacology and Pharmacokinetics (T. Chiou, Potential pitfalls in the typical pharmacokinetic research: Eects of the preliminary mixing of drug in blood and the pulmonary rst-pass elimination, J. Kemp, Antiarrhythmic eectiveness of intramuscular lidocaine: InЇuence of dierent injection sites, J. Dittert, Pharmacokinetics of ampicillin trihydrate, sodium ampicillin, and sodium dicloxacillin following intramuscular injection, J. Lowden, Inadequate serum ranges after intramuscular administration of diphenylhydantoin, Neurology, 23, 318±324 (1973). Duce, Oral absorption and disposition kinetics of lidocaine hydrochloride in dogs, J. Rowland, Eect of some physiologic elements on bioavailability of oral dosage varieties, in Dosage Form Design and Bioavailability (J. Oates, Plasma propranolol ranges in adults with observations in 4 children, Clin. Barr, Factors concerned in the evaluation of systemic or biologic availability of drug products, Drug Inf. Wislicki, Factors aecting acetylation in vivo of para-aminobenzoic acid by human subjects, Clin. Gubbens-Stibbe, Rectal bioavailability of lidocaine in man: Partial avoidance of ``rst-pass' metabolism, Clin. Pozza, Intranasal calcitonin and plasma calcium concentrations in regular subjects, Br. Banga, Iontophoretic (transdermal) supply of medicine: Overview of historic growth, J. Parasrampuria, Percutaneous supply of proteins and peptides utilizing iontophoretic techniques, J. Illum, Absorption of peptides and proteins from the respiratory tract and the potential for growth of domestically administered vaccine, Crit. Mapleson, An electrical analogue for uptake and exchange of inert gases and different brokers, J. Tillement, Pharmacokinetics of intravenously administered 125I-labelled human alpha-1-acid glycoprotein, Clin. Anderson, Leucocyte floor origin of human alpha-1-acid glycoprotein (orosomucoid), J. Fichtl, Tissue binding of medicine: Methods of willpower and pharmacokinetic consequences, in Plasma Binding of Drugs and Its Consequences (F. First, there could also be} chemical degradation of the energetic drug, resulting in a considerable lowering of the quantity of the therapeutic agent in the dosage kind. Second, although chemical degradation of the energetic drug extensive, a toxic product could also be} shaped in the decomposition process [1]. Dearborn [2] described a number of} examples during which the products of degradation are signicantly extra toxic than the original therapeutic agent. Thus, the conversions of tetracycline to epianhydrotetracycline, arsphenamine to oxophenarsine, and p-aminosalicylic acid to m-aminophenol in dosage varieties give rise to doubtlessly toxic brokers that, when ingested, could cause undesirable results. Phototoxicity has also been observed to happen following administration of chlordiazepoxide and nitrazepam [4]. Another instance of an opposed reaction a degradation product was provided by Neftel et al. Third, instability of a drug product can result in a decrease in its bioavailability somewhat than loss of drug or formation of toxic degradation products. This reduction in bioavailability a considerable lowering in the therapeutic ecacy of the dosage kind. This phenomenon could be caused by bodily and=or chemical adjustments in the excipients in the dosage kind, unbiased of whatever adjustments the energetic drug may have undergone. Fourth, there could also be} substantial adjustments in the bodily look of the dosage kind. Examples of those bodily adjustments include mottling of tablets, creaming of emulsions, and caking of suspensions. Although the therapeutic ecacy of the dosage kind could also be} unaected by these adjustments, the affected person will most likely lose condence in the drug product, which then has to be rejected. Fifth, while the drug substance itself may retain its potency, excipients similar to antimicrobial preservatives, solubilizers, emulsifying or suspending brokers may degrade, compromising the integrity of the drug product. A drug product, therefore, must fulfill stability criteria chemically, toxicologically, therapeutically, and physically. Basic ideas in pharmaceutical kinetics can often be applied to anticipate and quantify the Copyright © 2002 Marcel Dekker, Inc. Some chemical compounds, known as prodrugs [6,7], are designed to undergo chemical or enzymatic conversion in vivo to pharmacologically energetic medication. Prodrugs are employed to clear up one or a number of} problems introduced by energetic medication. They are pharmacologically inactive as such but are converted again in vivo to their mother or father (active) compounds. Naturally, the rate and extent of this conversion (governed by the same legal guidelines of kinetics described on this chapter) are the primary determinants of the therapeutic ecacy of those brokers.

References:

• https://aces.nmsu.edu/pubs/_b/100B15.pdf
• http://mauriciolema.webhost4life.com/rolmm/page1/files/ESPACV3.pdf
• https://www.cancer.org/content/dam/CRC/PDF/Public/8567.00.pdf