This article discusses the transmission of infectious diseases on passenger aircraft. It reviews several studies that found higher rates of illness among flight attendants and evidence of disease transmission on flights. While aircraft have high air exchange rates, the ventilation rate per person is lower than in buildings. Engineering calculations show airborne pathogen concentrations can be several times higher on planes than in offices. The article calls for more research on measures to limit airborne disease transmission in aircraft and other crowded enclosed spaces.
Histopathology of Multiple viral infections in lung of camel (Camelus Dromeda...iosrjce
IOSR Journal of Agriculture and Veterinary Science (IOSR-JAVS) is a double blind peer reviewed International Journal edited by the International Organization of Scientific Research (IOSR). The journal provides a common forum where all aspects of Agricultural and Veterinary Sciences are presented. The journal invites original papers, review articles, technical reports and short communications containing new insight into any aspect Agricultural and Veterinary Sciences that are not published or not being considered for publication elsewhere.
Aerodynamical Ventury effect for the prevention of the pandemy-Covid-19galantusgratus
The pandemic situation of the coronavirus in the world makes different scientific organizations to self organize for the fight and prevention of this infection by suggestions of various means and finally just vaccines. This paper suggest one eventually method of the application that is based on the aerodynamical effect of the flowing of fluids through the pipes. The pressure differences of the fluids through the pipe of changeable cross-sections is a possible application to prevent the pandemic virus infection. The laws of Bernoulli and the Venturi effect of the Pitot pipe serve as a prerequisite of the eventual elaboration of such modified pipe with the endotracheal tube to remove the beams of viruses from bronchial and pulmonary tracts of the lung with the supplemental application of ultraviolet or Roentgen beam.
Histopathology of Multiple viral infections in lung of camel (Camelus Dromeda...iosrjce
IOSR Journal of Agriculture and Veterinary Science (IOSR-JAVS) is a double blind peer reviewed International Journal edited by the International Organization of Scientific Research (IOSR). The journal provides a common forum where all aspects of Agricultural and Veterinary Sciences are presented. The journal invites original papers, review articles, technical reports and short communications containing new insight into any aspect Agricultural and Veterinary Sciences that are not published or not being considered for publication elsewhere.
Aerodynamical Ventury effect for the prevention of the pandemy-Covid-19galantusgratus
The pandemic situation of the coronavirus in the world makes different scientific organizations to self organize for the fight and prevention of this infection by suggestions of various means and finally just vaccines. This paper suggest one eventually method of the application that is based on the aerodynamical effect of the flowing of fluids through the pipes. The pressure differences of the fluids through the pipe of changeable cross-sections is a possible application to prevent the pandemic virus infection. The laws of Bernoulli and the Venturi effect of the Pitot pipe serve as a prerequisite of the eventual elaboration of such modified pipe with the endotracheal tube to remove the beams of viruses from bronchial and pulmonary tracts of the lung with the supplemental application of ultraviolet or Roentgen beam.
InfectionAccording to Philip ‘study[1] , 4.4 of the 2.6 mill.docxdirkrplav
Infection:
According to Philip ‘study[1] , 4.4% of the 2.6 million cumulative infections that compromise the simulated epidemic happened on the subway with the allocation from commuters (3.6%) to non-commuters (0.8%) shown the table .1 that the risk factor of 78.73 per 1,000 for infection, subway commuting poses a risk comparable to working. The activity column cataloged the most important circumstances that required recording, such as whether the participant was sitting, walking, or standing; whether the train was moving or stopped; and the position of the windows and vents[2].
Table.1 Baseline source of infection results. Source:[1]
The types of possible infection are epidemic, communicable disease, building related illness and sick building syndrome in subway
Epidemic
The epidemic spreading on subway networks are focused on the multi-scale mobility network consisting of short-scale commuting flows and long range line traffic. The epidemic of the subway will enhance the risk of a pandemic as evidenced by the spread of SARS (severe acute respiratory syndrome), avian influenza and H1N1 swine influenza in the past decade [3]. Severe acute respiratory syndrome (SARS) is predominantly spread by large-droplet ((>5 microns) transmission, and airborne transmission [4]. The other pandemic(avian influenza,H1N1 virus is via the alimentary canal and respiratory tract into the human body, moreover, it can also spread by human spray and secret of the respiratory tract.
Communicable disease
The infections of the communicable disease for the subway are influenza, mumps and epidemic cerebrospinal meningitis. For the influenza, it is spreading via the air by coughs or sneezes, creating aerosols containing the virus. Furthermore, it can also be transmitted by direct nasal secretions or through contact with contaminated surfaces [5].Mumps is the contagious disease that is spreading from person to person via the get in touch with respiratory secretions, such as saliva from an infected person. If an infected person in the subway is getting the coughs or sneezes, the droplets aerosolize will enter the eyes, nose, or mouth of another person. Moreover, the virus is survived on surfaces and then be transmitted after contact in a similar manner [6].
Building related illness
Building related illness is defined illness that knowing causative agent resulting from exposure to the building air [7]. According to Zhang’s study [8], the carriage of subway in which has the number of 120 ~130 individuals that the concentration of formaldehyde is 0.13 mg/m3. The standard of indoor air quality (GB/T 18683-2002) is regulated the highest concentration of formaldehyde about 0.12mg/m3 for indoor. Moreover, the symptoms of building related illness may be specific or mimic symptoms commonly relate to the flu, including fever, chills, and coughs. Acute lung and respiratory conditions can occur. The most common symptoms observed were lethargy (57%), nasal obstruction (47%), phar.
What do radioactive particles and viruses have in common? The answer is they’re both spread by aerosols and have a parameter (the neutron multiplication factor for radiation and the reproduction number, R0, for pathogens) to indicate whether the population of neutrons/ infected people is growing or shrinking. So technologies developed in the nuclear industry, such as Jacobs’ ANSWERS software, can be used to improve our understanding of the spread of COVID-19. Paul Smith, ANSWERS Technical Director, explains how in the current issue of Nuclear Future magazine.
ENT-436 CLC Hypothesis – Blue GroupInstructions DocumTanaMaeskm
ENT-436 CLC Hypothesis – Blue Group
Instructions: Document the agreed-upon team problem statement above the chart and complete each row and column as directed in the assignment.
Team: Kimberly Rowling, Marbel Donosso, Melinda Marshall, Nina Fajardo, Tamara Weatherton
Team problem statement: Installing airborne pathogen sensors on all commercial planes will protect travelers and flight staff from airborne pathogens reducing exposure by 80%.
Good Hypothesis
Better Version
Best Version
Independent Variable
Dependent Variable
Passengers should sanitize their hands before getting on to plane.
Sanitizer stations should be easily accessible before boarding the plane.
Every passenger should be provided hand sanitizer by the airline for constant use while on the airplane.
Sanitizers
Exposure rate
Passengers should be tested and provide the documents clearing them from any airborne disease before the flight.
Passengers should be tested by airlines at the airport before boarding the plane.
Passengers and the staff should be tested by the airline before boarding the plane, stopping the spread of airborne diseases before boarding.
Testing kits
Exposure rate
Ionization systems in commercial flights will limit exposure to airborne germs and pathogens.
Ionization systems in commercial flights will reduce passenger exposure to airborne germs and pathogens.
Needlepoint Bi-Polar Ionization Systems in commercial flights will effectively kill airborne germs and pathogens, reducing the risk of contaminating passengers by 75%.
Needlepoint Bi-Polar Ionization Systems
Exposure rate.
Checking temperatures of adult passengers after boarding would help eliminate airborne illness contamination.
Checking temperatures of adult and child passengers after boarding would help eliminate airborne illness contamination.
Checking temperatures of adult and child passengers at check-in, prior to boarding, would help eliminate airborne illness contamination.
Temperature checks.
Exposure rate.
Frequent scheduled maintenance to the HVAC airline systems can help ensure no other contaminants will create a false alert to the air sensor.
Weekly maintenance to the HVAC airline systems can help ensure no other contaminants will create a false alert to the air sensor.
Daily maintenance and changing of air filters to the HVAC airline systems can help ensure no other contaminants will create a false alert to the air sensor.
HVAC systems.
Exposure rate.
Adult passengers, 16 and over, are required to wear a face mask of their choice during the boarding process, but not while they are sleeping, eating, or drinking during the flight.
All passengers are required to wear a face mask of their choice during the boarding process and throughout the flight, except when they are eating.
All passengers are required to wear a new, high quality face mask provided by the airline just prior to boarding the flight. The mask must remain on except when eating.
Face masks.
Exposure rate.
Cabins including a max o ...
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
InfectionAccording to Philip ‘study[1] , 4.4 of the 2.6 mill.docxdirkrplav
Infection:
According to Philip ‘study[1] , 4.4% of the 2.6 million cumulative infections that compromise the simulated epidemic happened on the subway with the allocation from commuters (3.6%) to non-commuters (0.8%) shown the table .1 that the risk factor of 78.73 per 1,000 for infection, subway commuting poses a risk comparable to working. The activity column cataloged the most important circumstances that required recording, such as whether the participant was sitting, walking, or standing; whether the train was moving or stopped; and the position of the windows and vents[2].
Table.1 Baseline source of infection results. Source:[1]
The types of possible infection are epidemic, communicable disease, building related illness and sick building syndrome in subway
Epidemic
The epidemic spreading on subway networks are focused on the multi-scale mobility network consisting of short-scale commuting flows and long range line traffic. The epidemic of the subway will enhance the risk of a pandemic as evidenced by the spread of SARS (severe acute respiratory syndrome), avian influenza and H1N1 swine influenza in the past decade [3]. Severe acute respiratory syndrome (SARS) is predominantly spread by large-droplet ((>5 microns) transmission, and airborne transmission [4]. The other pandemic(avian influenza,H1N1 virus is via the alimentary canal and respiratory tract into the human body, moreover, it can also spread by human spray and secret of the respiratory tract.
Communicable disease
The infections of the communicable disease for the subway are influenza, mumps and epidemic cerebrospinal meningitis. For the influenza, it is spreading via the air by coughs or sneezes, creating aerosols containing the virus. Furthermore, it can also be transmitted by direct nasal secretions or through contact with contaminated surfaces [5].Mumps is the contagious disease that is spreading from person to person via the get in touch with respiratory secretions, such as saliva from an infected person. If an infected person in the subway is getting the coughs or sneezes, the droplets aerosolize will enter the eyes, nose, or mouth of another person. Moreover, the virus is survived on surfaces and then be transmitted after contact in a similar manner [6].
Building related illness
Building related illness is defined illness that knowing causative agent resulting from exposure to the building air [7]. According to Zhang’s study [8], the carriage of subway in which has the number of 120 ~130 individuals that the concentration of formaldehyde is 0.13 mg/m3. The standard of indoor air quality (GB/T 18683-2002) is regulated the highest concentration of formaldehyde about 0.12mg/m3 for indoor. Moreover, the symptoms of building related illness may be specific or mimic symptoms commonly relate to the flu, including fever, chills, and coughs. Acute lung and respiratory conditions can occur. The most common symptoms observed were lethargy (57%), nasal obstruction (47%), phar.
What do radioactive particles and viruses have in common? The answer is they’re both spread by aerosols and have a parameter (the neutron multiplication factor for radiation and the reproduction number, R0, for pathogens) to indicate whether the population of neutrons/ infected people is growing or shrinking. So technologies developed in the nuclear industry, such as Jacobs’ ANSWERS software, can be used to improve our understanding of the spread of COVID-19. Paul Smith, ANSWERS Technical Director, explains how in the current issue of Nuclear Future magazine.
ENT-436 CLC Hypothesis – Blue GroupInstructions DocumTanaMaeskm
ENT-436 CLC Hypothesis – Blue Group
Instructions: Document the agreed-upon team problem statement above the chart and complete each row and column as directed in the assignment.
Team: Kimberly Rowling, Marbel Donosso, Melinda Marshall, Nina Fajardo, Tamara Weatherton
Team problem statement: Installing airborne pathogen sensors on all commercial planes will protect travelers and flight staff from airborne pathogens reducing exposure by 80%.
Good Hypothesis
Better Version
Best Version
Independent Variable
Dependent Variable
Passengers should sanitize their hands before getting on to plane.
Sanitizer stations should be easily accessible before boarding the plane.
Every passenger should be provided hand sanitizer by the airline for constant use while on the airplane.
Sanitizers
Exposure rate
Passengers should be tested and provide the documents clearing them from any airborne disease before the flight.
Passengers should be tested by airlines at the airport before boarding the plane.
Passengers and the staff should be tested by the airline before boarding the plane, stopping the spread of airborne diseases before boarding.
Testing kits
Exposure rate
Ionization systems in commercial flights will limit exposure to airborne germs and pathogens.
Ionization systems in commercial flights will reduce passenger exposure to airborne germs and pathogens.
Needlepoint Bi-Polar Ionization Systems in commercial flights will effectively kill airborne germs and pathogens, reducing the risk of contaminating passengers by 75%.
Needlepoint Bi-Polar Ionization Systems
Exposure rate.
Checking temperatures of adult passengers after boarding would help eliminate airborne illness contamination.
Checking temperatures of adult and child passengers after boarding would help eliminate airborne illness contamination.
Checking temperatures of adult and child passengers at check-in, prior to boarding, would help eliminate airborne illness contamination.
Temperature checks.
Exposure rate.
Frequent scheduled maintenance to the HVAC airline systems can help ensure no other contaminants will create a false alert to the air sensor.
Weekly maintenance to the HVAC airline systems can help ensure no other contaminants will create a false alert to the air sensor.
Daily maintenance and changing of air filters to the HVAC airline systems can help ensure no other contaminants will create a false alert to the air sensor.
HVAC systems.
Exposure rate.
Adult passengers, 16 and over, are required to wear a face mask of their choice during the boarding process, but not while they are sleeping, eating, or drinking during the flight.
All passengers are required to wear a face mask of their choice during the boarding process and throughout the flight, except when they are eating.
All passengers are required to wear a new, high quality face mask provided by the airline just prior to boarding the flight. The mask must remain on except when eating.
Face masks.
Exposure rate.
Cabins including a max o ...
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Germs Flying And The Truth
1. This article was published in ASHRAE Journal, Vol. 52, April 2010. Copyright 2010 American Society of Heating, Refrigerating and Air-Conditioning Engineers,
Inc. Reprinted by permission from ASHRAE Journal at www.indoorair.ca. This article may not be copied nor distributed in either paper or digital form by other
parties without ASHRAE’s permission. For more information about ASHRAE, visit www.ashrae.org.
Germs,
Flying,
And the Truth
By Douglas S. Walkinshaw, Ph.D., P.Eng., Fellow ASHRAE nearly a day, prolong specific pathogen exposure times over
most other venues.
A significant number of air travelers say they are worried
about germs when they travel.1 But because incubation
periods between exposure to and contraction of a com-
municable disease vary up to several days (typically three for
A recent study by Wagner, et al.,13 calculated the impact of one
H1N1 infectious individual on board a large passenger airliner. It
found airborne transmission of this pathogen in the economy section
can cause two to five infections during a five-hour flight, five to 10
influenza and colds), travelers cannot be certain if they contracted during an 11-hour flight and seven to 17 during a 17-hour flight.
the disease on an airplane. However, research and engineering, Airborne transmission implicates HVAC systems and crowd-
while still in the initial stages, support this concern. ing, rather than individual responsibility. Naturally, the industry is
Brundage, et al.,2 found in 1988 that febrile illness rates sensitive to this. One official referred to potentially increased risk
were 50% higher in sealed-window, air-conditioned barracks of airborne disease transmission on aircraft as “a myth.”14 Others
than in operable window army barracks. Brundage postulated sometimes cite misleading information, e.g., aircraft ventilation
HVAC system design could play an important role in reducing systems, as in hospitals, use HEPA (high-efficiency particulate air)
lost productivity in the U.S. due to respiratory illness, which at filters, and air-change rates are 18 times higher than in buildings.
that time amounted to billions of dollars annually. But, consider the facts. The aircraft ventilation system sup-
More recently, a study found flight attendants and school plies only 15 to 20 cfm/p (7 L/s to 9 L/s) versus some 100 cfm/p
teachers report a higher prevalence of work-related upper (47 L/s) in buildings, even though its air change rate is 20 to 40
respiratory symptoms, chest illness, and cold or flu than the times higher. In aircraft, 50% of the ventilation rate per person is
general working population.3 Other studies indicate, with some outdoor air and 50% is air recirculated through HEPA filters. In
caveats, that there has been transmission of smallpox, measles, offices, 20% of the ventilation rate per person is outdoor air (two
tuberculosis, SARS (severe acute respiratory syndrome) and to three times that of aircraft) and 80% is recirculated through
seasonal influenza during commercial flights.4–9 filters. New office filters (e.g., MERV 13), although some 20%
Other evidence suggests that transmission of these diseases less efficient than HEPA in removing 0.3 micron particles, remove
could have an airborne component that is susceptible to venti- 6.4 times more 0.3 micron particles than aircraft HEPA filters
lation measures.10,11 Excluding those created as bioweapons, because the flows through them are 10 times higher.
there may still be others.12 Aircraft supply air is directed in a lateral row-wise circular
Most transportation systems such as subway trains and buses, fashion with initial velocities from the slot diffusers typically
as well as passenger aircraft, have high occupancy densities about 500 to 800 fpm (2.5 m/s to 4 m/s) (based on typical aircraft
(ODs; the number of people per unit volume of conditioned ventilation slot size and ventilation rates) (versus up to 300 fpm
space) compared with buildings. With the exception of cruise [1.5 m/s] for smaller building diffusers and up to 500 fpm [2.5
ships, the intermixing of persons from different population m/s] for larger ones).15 Recent research has demonstrated the
centers and continents in aircraft is unique. Further, passenger potential for these flow velocities to produce airborne particle
aircraft, with their assigned seating and flights ranging up to transmission between, as well as within, rows.
70 ASHRAE Journal ashrae.org April 2010
2. Officials sometimes cite misleading information. For example, aircraft ventilation systems,
as in hospitals, use HEPA filters, and air-change rates are 18 times higher than in buildings.
At a recent international symposium jointly organized by the U.S. than in typical office environments with MERV 13 filters, for the
Transportation Research Board (TRB) and the National Academy same pathogen emission rates and a uniformly mixed system.
of Sciences (NAS), experts in infectious diseases and aircraft ven- Because passenger aircraft cabin ODs are 20 to 40 times
tilation systems discussed the movement of potentially infectious higher than in office buildings, their pathogen concentrations
particles between rows fore and aft of the source.16 Two studies will reach peak equilibrium values sooner, with the result that
(following up on earlier studies, including work by Boeing17–19) time-weighted exposure ratios will be at least five times higher
found that these air velocities, and the turbulence induced at the than in offices, depending upon exposure duration, when the
airflow boundaries, disperse particle and gaseous contaminants same number of pathogens are emitted in each. In another
from a single source in two ways: past others in the same row and comparison, aircraft cabin occupancy densities are more than
in other rows in measurable quantities six or more rows forward three times higher than classroom ODs.
and backward. The contaminant flows in the area immediately sur- Here are the calculations:
rounding the source are relatively chaotic, and then more ordered Using the equation for average pathogen concentration C in
several rows away.20,21 a uniformly mixed system at time t in a space
At the symposium, several field investigations found that
C = [N/(V × Ve)][1 – exp(– Vt /v)] (1)
aisle seats and those near lavatories were most prone to disease
where
transfer. Mathematical modeling used to investigate how the
C = bioeffluent pathogen concentration in the space at
SARS virus was transmitted as far as seven rows away in the Air
time t
China flight 117 from Hong Kong to Beijing in 2003, found that
N = rate of bioeffluent pathogen generation/person in the
the wake created by occupant movement in the aisles can carry
space
an airborne contaminant this distance and when the movement
V = total ventilation air supply rate with no pathogens
stops the contaminant is distributed to the passengers seated in
Ve = efficiency of supplying the ventilation air to each
the adjacent aisle seats.22
occupant’s breathing zone
A study by Fabian23 found between <3.2 to 20 influenza
v = spatial volume/person
virus RNA copies per minute (up to 1,200 viruses per hour) in
the exhaled normal at rest breath (tidal breathing) of infected And using v and V values typical of aircraft cabins and offices,
persons, indicating that sneezing and coughing are not the only v = 32 ft3/p for the aircraft cabin
potential source of infectious aerosols. Seventy percent of the v = 1,430 ft3/p for the office
67 to 8,500 particles/L in the breath had diameters between 0.3 V = 15 cfm/p for the aircraft cabin (based on ASHRAE
and 0.5 microns, with rarely any larger than 5 microns.23 By Standard 161 and 100% influenza filtration by the
way of comparison, Duguid reported 6,200 cold viruses per HEPA filters)
hour emitted by an infected person at rest.24 Combined, the V = 84 cfm/p for the office (based on 20 cfm/p outside
symposium findings demonstrated that no systems or measures air and 80% virus filtration by MERV 13 filters for
are in place to prevent the airborne spread of infectious agents 80 cfm/p recirculation air)
over several rows, and that infectious disease transmission
And, using the average Fabian influenza generation rate:
within an aircraft cabin occurs before airborne pathogens are
N = 11 influenza virus generated per minute continu-
directed to the HEPA filters or exhausted outdoors.
ously in the exhaled breath of one influenza infected
Humidity also can play a role. Research published in 2007
person, not including coughing generation
indicates that lower levels of relative humidity (RH) such as
that in aircraft cabins shortly into cruising flight, increases the And, using:
potential for influenza and possibly other respiratory infections Ve = 1 for both settings
when a source is present.25 In contrast, higher levels of RH may
favor the survival and spread of the common cold.26 Solving Equation 1, and incorporating at rest awake inhalation
Relevant HVAC engineering calculations also serve to correct and exhalation rates of 0.28 cfm/p (0.13 L/s), the numbers of influ-
umbers influ-
misperceptions about risk of disease transmission on aircraft. enza virus particles inhaled by office and aircraft groups exposed
Although aircraft air change rates are higher than in office to the exhaled breath of one infected person versus exposure time
buildings, ventilation and recirculation flow rates per person are shown in Figure 1. It can be seen that after eight hours in the
are lower and engineering equations indicate that airborne 0.3 aircraft cabin, there will be 98 influenza virus particles inhaled by
micron and larger pathogen concentrations will be at least four previously uninfected persons, and up to nine infections for a 10
times higher in passenger aircraft equipped with HEPA filters virus particle dose criterion. By comparison, for the same exposure
April 2010 ASHRAE Journal 71
3. period in the office, there will be 17 virus particles inhaled and up 110
to one infection. The location of persons most likely to be infected 100
Number of Influenza Virus Inhaled by Group
will be determined by proximity to the infected person, suscept-
90
ibility, air current patterns, and aisle or not seat location.
80
The ratio of virus inhalation for the two exposure settings is
shown in Figure 2. It can be seen that for exposures over two 70
hours, Ve for the aircraft must be doubled and V tripled to provide 60
an office building equivalent level of protection for the same 50
activity level of occupants. However, breathing rates on aircraft Aircraft Passengers
40
typically will decrease as the flight duration increases and more Office Workers
people are dozing. If the infected person also dozes, this could 30
result in up to one-third reduction in average breathing rate and 20
virus inhalation as the flight progresses. This commensurately 10
decreases the aforementioned V and Ve multiples required to
0
reduce virus inhalation rates in aircraft by a four times rather 0 60 120 180 240 300 360 420 480
than a six times reduction factor to provide office building level Exposure Duration, Minutes
equivalent protection. Other pathogens aerosolized by passenger Figure 1: Number of influenza virus particles inhaled by office
movement also would decrease as fewer passengers move about worker and aircraft passenger groups exposed to the exhaled breath
the cabin. A leveling off of airborne viable bacterial abundance (coughing not included) of one infected person for the same “at rest
after midflight has been noted by La Duc, et al.27 awake” activity level in each.
To date, the role of HVAC system design and operation to
help control infectious disease transmission has been mainly 35
limited to the use of HEPA filtration and air purification in
the main recirculation system and, in the case of health-care 30
facilities, isolating infectious patients in separately ventilated,
Virus Inhalation: Aircraft/Office
depressurized rooms. 25
The effectiveness of HEPA filters in trapping airborne cold
Ratio of Virus Inhalation: Aircraft
virus was tested in a study of passenger aircraft, where some 20 Passengers/Office Workers
flights had no recirculation and some had 50% recirculation
through HEPA filters.28 This study found no difference in the
15
rates of transmission of upper respiratory illness symptoms,
runny nose and colds, in two-hour flights. Although the flight
durations were short, this suggests air filtration can be a useful 10
measure in the prevention of these illnesses.
In a related development, the aircraft cabin air supply that is 5
used to ventilate and pressurize the cabin, is also used to filter
the air from around the occupants using the flow entrainment 0
0 30 60 90 120 150 180
created by the high velocity airflows out of the gaspers. This Exposure Duration, Minutes
technique effectively doubles the cabin air filtration rate and
increases the ventilation effectiveness without adding local air Figure 2: Ratio of virus inhalation by aircraft passengers to office
circulation fans or using extra energy.29 workers versus exposure time for the same number of infected per-
It is time for ASHRAE to begin the multidisciplinary research sons and “at rest awake” activity level in each group.
and development necessary to identify infectious disease miti-
gation measures for critical settings, and set criteria that will • Viability time limits for pathogens of concern;
effectively limit airborne infections of most concern. These • Total pathogen-clearing airflow per person to be provided
would include: to the breathing zone in proportion to airflow effective-
• Design exposure periods to be used for different settings; ness (Ve) in diluting and removing pathogens in the
• Design occupancy densities to use for different settings; breathing zone;
• Design humidity conditions to use for different settings; • Ve for each occupant’s breathing zone to be used for dif-
• Occupant breathing rates to be used for different settings; ferent spaces and diffuser types and arrangements; and
• Pathogen dose criteria to be used for pathogens of air- • Removal/immobilization rates per unit airflow to be used
borne concern; for each pathogen of concern for the various air filters
• Coughing and breathing aerosol size ranges, dispersion and purifiers available.
distances and settling rates for different settings for each Regarding pathogen aerosol size range, settling rates, and vi-
pathogen of concern; ability time limits, the higher the OD the sooner the equilibrium
72 ASHRAE Journal ashrae.org April 2010
4. concentration is reached and the less important these factors are 8. Kenyon, T.A., et al. 1996. “Transmission of multidrug-resistant
in limiting pathogen dispersion distances and exposures. The mycobacterium tuberculosis during a long airplane flight.” N Engl J
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The development of these criteria for specific pathogens will of infectious agents in the built environment—a multidisciplinary
require dedicated multi-year committee work by individuals from systematic review.” Indoor Air 17:2 – 18.
11. Blachere, F.M., et al. 2009. “Measurement of airborne influenza
the ASHRAE disciplines and from infectious disease disciplines. virus in a hospital emergency department.” CID 48:438 – 440.
It will need to involve collaboration with health agencies as well. 12. Sattar S.A., M.K. Ijaz. 2007. “Airborne viruses.” In Manual of
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potential for within-flight transmission of influenza A (H1N1).” BMC
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defined for the next five years and research is beginning. 14. Freeman, L. 2009. “Fear of flu no reason to avoid flying, area
While ASHRAE is working on new standards, industry health and airline officials say.” Naples News, Naples, Fla. Nov. 21.
spokespersons could recommend some simple-to-implement 15. ANSI/ASHRAE Standard 161-2007, Air Quality Within Com-
precautionary measures that passengers might take. Preflight mercial Aircraft.
16. Transportation Research Board. 2009. Reference materials for
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from touching one’s face (wearing a mask helps here); periodic- the flow field.” ASHRAE Transactions 111(1):755 – 763.
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20. Bennett, J., J. Topmiller, Y. Zhang, W. Dietrich. 2009. “Sum-
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April 2010 ASHRAE Journal 73