Книги з теми "Borel measure"

Major abdominal surgery and laparotomy are common procedures that are associated with a high risk of mortality and morbidity, especially in the elderly. Outcomes can be improved by formal risk stratification, appropriate perioperative resuscitation and optimization, early surgery, senior anaesthetist involvement, and careful postoperative critical. Assessment of dehydration is imperative because fluid losses are very common and may be difficult to measure. Hypothermia is common, and measures should be instituted to conserve heat loss. Use of nitrous oxide can cause bowel distension and should be avoided. Elderly patients should receive postoperative care in an environment that is appropriate to the degree of comorbidity and the type of surgery. Effective analgesia is known to improve outcome. Only experienced anaesthetists should manage major and emergency abdominal surgery.

Gastrointestinal issues are among the most common problems in older adults, who present a unique set of issues related to the aging gut. An integrative physician attends to these issues by avoiding polypharmacy, reducing overuse of invasive procedures and medications, optimizing nutritional recommendations, and supporting quality of life. This chapter describes a variety of approaches that include functional medicine, lifestyle, mind-body, bioenergetics, botanical, herbal, and other measures to improve gut health. Specific topics covered are gastroesophageal reflux disease, gastritis, ulcers, colon cancer, constipation, diarrhea, diverticulosis, irritable bowel syndrome, inflammatory bowel disease, and hemorrhoids. An illustrative case study is provided.

This book provides architects, engineers, builders, foresters, members of the pest control and timber industries, and the general public with a ready source of reference to the more important wood borers and termites encountered in Australia. Many species of timber can be attacked by wood-destroying insects such as wood borers and termites.With some species of wood borer or termite, an infestation can result in serious economic damage necessitating treatment and repair or replacement of the affected timber. With other species, remedial action is unnecessary. In many situations, preventive measures can significantly reduce the damage caused by these wood-destroying insects.

It tends to be assumed that the Anglo-Scottish relationship has defined modern Scottish literature. This chapter contends that religion rather than nationhood has been the dominant feature of Scottish literature within the Union, and that for most Scots, certainly from the mid-eighteenth-century Secessions, by way of the Disruption (1843), to the reunion of the Church of Scotland with the United Free Church in 1929, denominational allegiances within Scottish Protestantism, often within Presbyterianism itself, were the principal vehicles of identity. Scotland had a rich periodical press during the nineteenth century, but one splintered along denominational lines. Every denomination had its magazine, and Scottish reviewing, and literature more generally, bore marked denominational inflections. Moreover, the vivid characterization, claustrophobic Calvinism, and ingenious plotting of the Whig-Presbyterian novel have continued in no small measure—in works by Robin Jenkins and, more recently, James Robertson—to provide a narrative template for secularized, postmodern Scottish literature.

This chapter covers the evidence for treatment algorithms and treatment to target in PsA. Evidence for treatment algorithms including step up vs step down approaches to prescribing and early vs delayed treatment is discussed. EULAR recommendations for treating to target in SpA are outlined with a summary of the level of evidence available at that time. Key outcome measures that could be utilized as targets in PsA are reviewed with discussion of their merits and deficiencies. A detailed description of the first treat to target study in PsA is presented: the TICOPA study. The impact of comorbidities on treatment decisions is discussed, both related SpA conditions such as uveitis and inflammatory bowel disease, and non-SpA comorbidities such as the metabolic syndrome and liver disease. Finally, suggestions for translation into clinical practice are outlined, highlighting the need for multi-speciality collaborative working, full assessment of disease activity and subsequent optimal treatment.

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide and although young male adults are at particular risk, it affects all ages. TBI often occurs in the presence of significant extracranial injuries and immediate management focuses on the ABCs—airway with cervical spine control, breathing, and circulation. Best outcomes are achieved by management in centres that can offer comprehensive neurological critical care and appropriate management for extracranial injuries. If patients require transfer from an admitting hospital to a specialist centre, the transfer must be carried out by an appropriately skilled and equipped transport team. The focus of specific TBI management is on the avoidance of secondary injury to the brain. The principles of management are to avoid hypotension and hypoxia, control intracranial pressure and maintain cerebral perfusion pressure above 60 mmHg. Management of increased intracranial pressure is generally by a stepwise approach starting with sedation and analgesia, lung protective mechanical ventilation to normocarbia in a 30° head-up position, maintenance of oxygenation, and blood pressure. Additional measures include paralysis with a neuromuscular blocking agent, CSF drainage via an external ventricular drain, osmolar therapy with mannitol or hypertonic saline, and moderate hypothermia. Refractory intracranial hypertension may be treated surgically with decompressive craniectomy or medically with high dose barbiturate sedation. General supportive measures include provision of adequate nutrition preferably by the enteral route, thromboembolism prophylaxis, skin and bowel care, and management of all extracranial injuries.

Visceral pain is pain that arises from, in, or around internal organs. Common examples include chest pain and functional abdominal pain. In palliative medicine, well-known visceral pain syndromes include pain from pancreatic cancer and bowel obstruction. Recent advances have increased our understanding of the diagnostic challenges and therapeutic possibilities for patients with visceral pain syndromes. Understanding the basis of referred pain is a key component of patient assessment. The complexity of visceral nociception and pain signalling is being unravelled through anatomical, immunohistochemical, and functional studies. On a molecular level, families of receptors and signalling proteins have now been described that will lead to a future with innovative therapies. This knowledge has developed within the paradigms of pain pathways, peripheral activation and peripheral and central sensitization, thereby linking and distinguishing visceral pain from somatic and neuropathic pain. Treatment options for visceral pain in palliative care encompass a wide variety of medical, interventional, and psychological approaches. With appropriate diagnostic measures and careful consideration of therapeutic options, most patients can achieve satisfactory relief.

Significantly revised and updated, the second edition of this popular quick reference guide provides information and advice on 190 areas of current pediatric care, everything from abdominal pain and ADHD, to headache and herpes infections, to weight loss and wheezing. This indispensable resource delivers practical, action-orientated, clinical solutions for healthcare professionals to use during or between patient encounters. Authoritative content is presented in a concise outline format that helps speed and simplify decision-making. Regardless of the patient presentation you're confronted with, you'll have quick access to the help you need to Efficiently evaluate signs and symptoms. Order the right screening/diagnostic tests. Implement approved therapeutic strategies. Prescribe safe and effective medications. Recommend proven prevention measures. Confidently respond to parent questions. 35 new chapters including Adjustment disorder Anxiety Ataxia Coagulation disorders Cyanosis Dental problems Depression Drug interactions and adverse effects Fetal alcohol spectrum disorder Fragile X syndrome Hemangiomas Hypocalcemia, hypercalcemia, and hypercalcuria Inattention Inflammatory bowel disease Klinefelter syndrome Learning difficulty Learning disorders Metabolic disorders beyond the newborn period Munchausen syndrome by proxy: medical child abuse Neural tube defects Oppositional defiant disorder Pancreatitis Papulosquamous disease Pierre Robin syndrome Prader-Willi syndrome Screening for genetic-metabolic diseases Self-harm Sexual abuse of children Sleep disturbances Speech and language concerns Substance use Symptoms of emotional disturbances in young children (birth to 5) Temper tantrums and breath-holding spells Turner syndrome and Noonan syndrome Vitamin D inadequacy

Verocytotoxin (VT)-producing Escherichia coli (VTEC), also known as Shiga toxin producing E. coli (STEC), are zoonotic agents, which cause a potentially fatal illness whose clinical spectrum includes diarrhoea, haemorrhagic colitis, and the haemolytic uraemic syndrome (HUS). VTEC are of serious public health concern because of their association with large outbreaks and with HUS, which is the leading cause of acute renal failure in children. Although over 200 different OH serotypes of VTEC have been associated with human illness, the vast majority of reported outbreaks and sporadic cases of VTEC-infection in humans have been associated with serotype O157:H7.VTs constitute a family of related protein subunit exotoxins, the major ones implicated in human disease being VT1, VT2, and VT2c. Following their translocation into the circulation, VTs bind to endothelial cells of the renal glomeruli, and of other organs and tissues via a specific receptor globotriosylceramide (Gb 3), are internalized by a process of receptor-mediated endocytosis, and cause subcellular damage that results in the characteristic microangiopathic disease observed in HUS.The incubation period of VTEC-associated illness is about 3–5 days. After ingestion VTEC (especially of serotype O157:H7) multiply in the bowel and colonize the mucosa of probably the large bowel with a characteristic attaching and effacing (AE) cytopathology. Colonization is followed by the translocation of VTs into the circulation and the subsequent manifestation of disease.The majority of patients with uncomplicated VTEC infection recover fully with general supportive measures. Historically, the case-fatality rate was high for HUS. However, improvement in the treatment of renal failure and the attendant biochemical disturbances has substantially improved the outlook, although long-term sequelae may develop.Ruminants, especially cattle, are the main reservoirs of VTEC. Infection is acquired through the ingestion of contaminated food, especially under-cooked hamburger, through direct contact with animals, via contaminated water or environments, or via personto-person transmission.The occurrence of large outbreaks of food-borne VTEC-associated illness has promoted close scrutiny of this zoonoses at all levels in the chain of transmission, including the farm, abattoir, food processing, packaging and distribution plants, the wholesaler, the retailer and the consumer. While eradication of VTEC O157 at the farm may not be an option, interventions to increase animal resistance or to decrease animal exposure are being developed and validated. Hazard Analysis and Critical Control Programmes are being implemented in the processing sector and appear to be associated with temporal decreases in VTEC serotype O157 illness in humans. Education programmes targeting food handling procedures and hygiene practices are being advocated at the retail and consumer level. Continued efforts at all stages from the farm to the consumer will be necessary to reduce the risk of VTEC-associated illness in humans.

The coronavirus disease 2019 (COVID-19) outbreak has sparked a global health crisis that has altered our perceptions of the world and our daily lives. Not only has the velocity of infection and transmission patterns undermined our feeling of agency, but the safety measures to restrict the virus's spread also demanded social and physical separation, prohibiting us from seeking solace in the company of others. The coronavirus 2019 (COVID-19) pandemic has wreaked havoc on daily life and normal activities as well as having serious health, economic, financial, and societal consequences Lockdowns and physical/social distancing measures were enforced in numerous countries throughout the world beginning in March 2020. COVID-19 has claimed the lives of hundreds of thousands of people all over the world. This high death toll, combined with the rapid changes in daily life brought on by the COVID-19 pandemic, may have a negative impact on child and adolescent mental health. Individuals' reactions to the security measures adopted to combat the epidemic varied depending on the social roles they played. Some segments of the population seem to be more exposed to the risk of anxious, depressive, and post-traumatic symptoms as the population is more susceptible to stress. COVID-19 pandemic has generated a situation like mass hysteria or fear. This mass fear of COVID-19, termed as “Coronaphobia”, has generated a plethora of psychiatric manifestations across societies. In India, the first and foremost responses to the pandemic have been fear and a sense of clear and imminent danger. Fears have ranged from those based on facts to unfounded fears based on misinformation circulating in the media, particularly social media. All of us respond differently to the barrage of information from all the available sources. It is equally important to consider the impact of the various phases of the pandemic on children, the elderly and pregnant women. The worries of adults can be transmitted to children and make them anxious and fearful. They can become very easily bored, angry and frustrated. Without an opportunity for outdoor play and socialization, they may become increasingly engrossed in social media and online entertainment, which can make them even more socially isolated when they emerge out of this situation. Parents need to know means of keeping the children engaged, providing an opportunity to learn new skills at home, as well as encourage children to participate in activities, get them engaged in “edutainment” and hone their extracurricular skills as well. Children with special needs may need innovative approaches to engage them and keep them active at home. For the elderly, they can feel further isolated and neglected, become more worried about their families, and increasingly worried about their health. They may not have the support systems to care for them, particularly in terms of their medical needs. This can aggravate into anxiety and depression.

Research concerns the problem of landslide movement, which is one of the most important geomorphological processes in the Carpathians. The aim of the studies is to determine the temporal and spatial complexity of landslide activity and to demonstrate the suitability of using different species of conifers in the dendrogeomorphological method. The Sawicki landslide located in Beskid Niski Mts., which is one of the largest landslides in the Polish Flysch Carpathians, was selected for dendrogeomorphological analysis. The dendrogeomorphological method and geomorphological mapping were used in the research. 1078 samples from conifers (fir, spruce, larch and pine) growing on the Sawicki landslide and its immediate surroundings were taken using an increment borer in 2013- 2018. The cores were taken from the upslope and downslope side of the tree stump. The width of annual tree rings were measured for each extracted core sample. The landslide activity was assessed on the basis of the eccentricity, the eccentricity index and its yearly variation. Geological and topographic maps, published data on landslides activity in the research area, precipitation data from the Research Station in Szymbark (Institute of Geography and Spatial Organization Polish Academy of Science) for 1968-2017 and from the meteorological station in Krynica (Institute of Meteorology and Water Management) for 1881-2010 were also used for dendrogeomorphological research of Sawicki landslide. The research shows that the Sawicki landslide is characterized by varied temporal and spatial complexity of landslide activity. The dynamics of displacements within the research sites and research sub-sites, including various fragments of landslides, and movements of colluvial packages is spatially mosaic and chaotic in time. Mass movements covering almost the entire surface of the landslide occurred in the years 1913-1914 and 1974-1975, while in the years 1888, 1906-1907, 1916, 1918, 1929, 1965, 1973, 1980, 1983-1985, 1997 landslide activity was recorded only in its particular parts. The largest variation in the dynamics of landslide movements is characteristic for the period 1970-1985. It was also found that in the initial stage of formation of the landslide tongue, the colluviums movement is disordered. During further downhill movement, the direction of displacement is arranged. Periods of Sawicki landslide activity refers to extremely humid years (62%) and wet years (48%) and they are consistent with the years of landslides activity in Szymbark, listed in the current literature of the subject. The most predisposed conifer species to dendrogeomorphological analysis were spruce, larch and fir. Despite its limitations, the dendrogeomorphological method is a useful tool in landslide activity research.