By L. Fadi. Life Pacific College.

O’Connor Trends in patients’ radiation protection: Manufacturers’ research strategy as outlined in industrial property documents B generic 10 mg olmesartan blood pressure healthy vs unhealthy. Spyropoulos The need to foster collaboration between medical physicists and manufacturers through standards in the area of radiation protection of patients A effective 20 mg olmesartan heart attack kush. Ghezaiel Estimate of the annual dose from background radiation inside hospitals and health centres of Kurdistan region and its impact on workers and patients A discount olmesartan 20mg with amex hypertension nos 4019. Ismail The consequences of the lack of specialists in radiation protection in health services and different ways to overcome it R. Katumba Operation of radioprotection committees in hospitals that do not have a specialized radiation protection service R. Lunardon Academic education, clinical training and professional recognition of medical physicists in Argentina M. Mairal Failure on the steps of simulation, planning and delivery of radiation dose in radiotherapy — A reality in clinical practice L. Radiation dose to paediatrics during chest and abdomen X ray examinations at Muhimbili National Hospital (Tanzania): Initial results W. Muhogora Safety education and training in radiation protection for medical workers — A developing country’s experience M. Paci Awareness and attitude of radiographers towards radiation protection in Bangladesh S. Rao Argentina’s situation in tomography and the use of reference levels as a tool to optimize dose in procedures R. Sapiin Adherence to radiation protection rules and procedures in developing countries — A case for Uganda M. Seguya Overview of occupational radiation protection of medical workers in Estonia 2001-2011 J. Shubina Evolution of regulations to ensure radiological safety in diagnostic radiology — Practice in India A. Sonawane Strategy of Indonesia’s nuclear energy regulatory agency to control patient dose in the utilization of radiology diagnostic equipment A. Sutrisno Results of a national program of radiation protection of patients conducted by the relevant medical societies (8 years’ experience) R. Akahane Managing radiation protection and safety in the hospital — Success factors and challenges A. Almén Estimation of population doses from diagnostic radiological and nuclear medicine procedures: A tool for authorities to promote justification and optimization R. Bly Individual radiosensitivity and increasing medical doses: Two serious risk factors for patients M. Bourguignon First results of population dose assessment from X ray and nuclear medicine examinations in Serbia O. Guibelalde Education and training in radiation protection for health care professionals — A survey in Finland R. Pesznyák Methodology and inaccuracies in the estimation of collective effective dose from diagnostic and interventional procedures in a university hospital E. Setting the Scene for the The conference was held in Bonn, 3–7 December 2012, and aimed, in particular, to: Next Decade • Indicate gaps in current approaches to radiation protection in medicine; • Identify tools for improving radiation protection in medicine; • Review advances, challenges and opportunities in the field of radiation protection in medicine; Proceedings of an • Assess the impact of the International Action Plan for the International Conference Radiation Protection of Patients, in order to prepare new international recommendations, taking into account newer 3–7 December 2012 developments. It resulted in the Bonn Call for Action, which will focus efforts Bonn, Germany in radiation protection in medicine in the next decade, and maximize the positive impact of such efforts. Key: b Ref: Myocardial Infarction (591) Davidson’s Principles and Practice of Medicine. A thirty five year old man presents in a clinic with history of chronic productive cough that is worse in the morning and brought on by changes in posture. Key: b Ref: Bronchiectasis (Page 684) Davidson’s Principles and Practice of Medicine. Key: c Ref: Adverse Reaction of First Line Anti Tuberculosis Drugs (Page 702) Davidson’s Principles and Practice of Medicine. A fifteen year old boy who is diabetic presents with pain abdomen, vomiting and shortness of breath. Key: a Ref: Diabetic Ketoacidosis (Page 820) Davidson’s Principles and Practice of Medicine. A ten year old boy gives history of swelling of body starting from face and more on getting up in the morning. On examination his blood pressure is normal, pallor is absent and jugular venous pressure is not raised. Key: e Ref: Nephrotic Syndrome (Page 480) Davidson’s Principles and Practice of Medicine. A young girl comes in the cardiology ward with history of breathlessness and palpitations for last one year. After auscultation of precordium cardiology registrar makes diagnosis of mitral stenosis. The most important sign on which this diagnosis is based is: a) Ejection systolic murmur. Key: b Ref: Mitral Stenosis (Page 619) Davidson’s Principles and Practice of Medicine. Key: a Ref: Rheumatic Fever (Page 618) Davidson’s Principles and Practice of Medicine. An old lady presents with history of fever and left sided chest pain for one month. Examination of respiratory system shows decreased chest movements, stony dull percussion note and absent breath sounds on left side. Key: d Ref: Clinical Exam of Respiratory System (Page 649) Davidson’s Principles and Practice of Medicine. A forty year old woman gives history of fever for last three weeks accompanied by dry cough, night sweats and weight loss. Key: a Ref: Tuberculosis (Page 696) Davidson’s Principles and Practice of Medicine. A young girl complains of nocturnal cough and shortness of breath which disturbs her sleep. Key: c Ref: Bronchial Asthma (Page 673) Davidson’s Principles and Practice of Medicine. A fifteen year old girl presents with history of fever, bleeding from gums and pallor for last fifteen days. Key: a Ref: Acute Leukemia (Page 1040) Davidson’s Principles and Practice of Medicine. Which of the following drugs is used in the treatment of hyperkalemia in acute renal failure: a) Amiloride. Key: d Ref: Treatment of Hyperkalemia, Acute Renal Failure Davidson’s Principles and Practice of Medicine. For the patient with history of fever, headache and neck stiffness, the most important investigation is: a) Cerebrospinal fluid examination. Key: a Ref: Meningitis (Page 1224) Davidson’s Principles and Practice of Medicine. The most common risk factor for chronic obstructive pulmonary disease is: a) Air pollution.

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Athletes With minor exceptions order 40mg olmesartan otc pulse pressure 63, dietary recommendations for athletes are not distinguished from the general population cheap olmesartan 20mg overnight delivery arteria labialis superior. As described in Chapter 12 discount olmesartan 20mg overnight delivery heart attack damage, the amount of dietary energy from the recommended nutrient mix should be adjusted to achieve or maintain optimal body weight for competitive athletes and others engaged in similarly demanding physical activities. As described by Dewey and colleagues (1996), the lower value is similar to average energy expenditure of preschool children and to energy expenditure for maintenance and activity of recovering malnourished children in Peru. The higher value is typical of normal infants at 9–12 months of age, but may be higher than would be expected of malnourished children if they are less active. While some athletes may be able to sustain extremely high power outputs over days or even weeks (such as in the Tour de France bicycle race), such endeavors are episodic and cannot be sustained indefi- nitely. Despite the difference in scope of energy flux associated with partici- pation in sports and extremely demanding physical activities such as mara- thon running and military operations, several advantages are associated with different forms of exercise. For example, resistance exercise promotes muscle hypertrophy and changes in body composition by increasing the ratio of muscle to total body mass (Brooks et al. Athletes need- ing to increase strength will necessarily employ resistance exercises while ensuring that dietary energy is sufficient to increase muscle mass. Total body mass may increase, remain the same, or decrease depending on energy balance. Athletes needing to decrease body mass to obtain bio- mechanical advantages will necessarily increase total exercise energy out- put, reduce energy input, or use a combination of the two approaches. As distinct from weight loss by diet alone, having a major exercise component will serve to preserve lean body mass even in the face of negative energy balance. The ability of healthy indi- viduals to compensate for increases in energy intake by increasing energy expenditure (either for physical activity or resting metabolism) depends on physiological and behavioral factors. When individuals are given a diet providing a fixed (but limited) amount of energy in excess of the require- ments to maintain body weight, they will initially gain weight. However, over a period of several weeks, their energy expenditure will increase, mostly (Durnin, 1990; Ravussin et al. Some reports indicate that the magnitude of the reduction in energy expenditure when energy intake is reduced is greater than the corresponding increase in energy expenditure when energy intake is increased (Saltzman and Roberts, 1995). It is likely that for most individuals the principal mechanism for maintaining body weight is by controlling food intake rather than physical activity (Jequier and Tappy, 1999). This level would also provide some margin for weight gain in mid-life without surpassing the 25 kg/m2 threshold. In the case of obese individuals who need to lose weight to improve their health, energy intakes that cause adverse risk are those that are higher than those needed to lose weight without causing negative health consequences. Summary Because of the direct impact of deviations from energy balance on body weight and of changes in body weight, body-weight data represent critical indicators of the adequacy of energy intake. The uncertainty factor would be one as there is no uncertainty in the fact that overconsumption of energy leads to weight gain. Men 19 through 30 years of age had the highest reported energy intake with the 99th percentile of intake at 5,378 kcal/d. This is particularly true for young children 3 to 5 years of age, adolescent boys, and adult men and women 40 through 60 years of age. Multivariate-adjusted relative risk/hazard risk/odds ratio estimates were used in this table whenever possible. Multivariate-adjusted relative risk/ hazard risk/odds ratio estimates were used in this table whenever possible. Multivariate-adjusted relative risk/hazard risk/odds ratio estimates were used in this table whenever possible. Multivariate-adjusted relative risk/hazard risk/odds ratio estimates were used in this table whenever possible. Multivariate-adjusted relative risk/hazard risk/odds ratio estimates were used in this table whenever possible. Multivariate-adjusted relative risk/hazard risk/odds ratio estimates were used in this table whenever possible. Short-term energy balance: Relationship with protein, carbohydrate, and fat balances. Studies in human lactation: Milk composition and daily secretion rates of macronutrients in the first year of lactation. The safety and efficacy of a controlled low-energy (‘very-low-calorie’) diet in the treatment of non-insulin-dependent diabetes and obesity. Energy and macronutrient content of human milk during early lactation from mothers giving birth prematurely and at term. Metabolic and endocrine responses to cold air in women differing in aerobic capacity. Metabolic rates during recovery from protein–calorie malnutrition: The need for a new concept of specific dynamic action. Glucose metabolism during fasting through human pregnancy: Comparison of tracer method with respiratory calorimetry. Obesity as an adaptation to a high-fat diet: Evidence from a cross-sectional study. Impact of the v/v 55 polymorphism of the uncoupling protein 2 gene on 24-h energy expenditure and substrate oxidation. Interrelation of age, obesity, cigarette smoking, and blood pressure in hypertensive patients. A meta-analysis of the factors affecting exercise- induced changes in body mass, fat mass and fat-free mass in males and females. Psychological measures of eating behavior and the accuracy of 3 common dietary assessment methods in healthy postmenopausal women. A Metabolic Study with Special Refer- ence to the Efficiency of the Human Body as a Machine. The Gaseous Metabolism of Infants, with Special Reference to its Relation of Pulse-Rate and Muscular Activity. Using biochemical markers to assess the validity of prospective dietary assessment methods and the effect of energy adjustment. Comparison of dietary assessment methods in nutritional epi- demiology: Weighed records v. Variations and deter- minants of energy expenditure as measured by whole-body indirect calorimetry during puberty and adolescence. Total energy expenditure and spontaneous activity in relation to training in obese boys. Measurements of total energy expenditure provide insights into the validity of dietary measurements of energy intake. Human energy expenditure in affluent societies: An analysis of 574 doubly-labelled water measurements. Thermogenic response to temperature, exercise and food stimuli in lean and obese women, studied by 24 h direct calorimetry. Thermogenic response to an oral glucose load in man: Comparison between young and elderly subjects. Daily energy expendi- ture and physical activity assessed by an activity diary in 374 randomly selected 15-year-old adolescents.

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Von Mises makes the point that the difference between communism and fascism on the one hand olmesartan 40 mg otc arteriography, and socialism on the other is only 39 in the means by which to achieve identical ends olmesartan 20mg cheap hypertension young adults. This per- manent tutelage buy olmesartan mastercard arteria apendicular, which von Mises called etatism, and British commentators call the nanny state, exists, as yet, in Western democracies only in a diluted version because of various con- stitutional, philosophical, moral and political obstacles. As Talmon showed, the Left starts from the premise that man is perfectible, as Rousseau believed, and by changing the unhealthy environment, created by an unfettered capitalism, man can be made healthy and happy, even though at times some degree of coercion might become necessary. For example, the poor are known to suffer more from diseases and have shorter life-expectancy, but should this be blamed on their lifestyle or on the political conditions which are the causes of poverty? By linking poverty with disease (which is not unreasonable on its own), Marxists promise that in a classless society the health of the poor will improve. Furthermore, the Left, in their various health manifestos, propose increased powers to prescribe healthy activities and proscribe unhealthy activities. To maintain the nation in a high state of readiness to defend the supremacy of the race, people should be responsible for their own health. Typical political statements are contained in Department of Health documents which see health as a matter over which the individual has control and responsibility. It makes little difference to the citizen whether statements such as the list of national targets for physical activity in England, issued by the Faculty of Public Health Medicine in February 1993, emanate from the Left or the Right, as in either case the citizen is threatened by the tyranny of the majority, if he chooses not to fulfil his quota of exercise. Any prescriptive system to make man free, or healthy, ends by enslaving him, or by taking health away from him. Those who conform, whether out of greed, cowardice, stupidity or genuine enthusiasm. Fascism and communism are histori- cal forms of totalitarianism which are unlikely to re-emerge in the same form in Western democracies, and even less so under the same name. The brave new world of the year 2000 is being heralded in the name of medical science, genetics, and the promise of longevity. The criminalisation of motherhood was dis- cussed by Ernest Drucker, professor of epidemiology and social medicine at Montefiore Medical Center in the Bronx, where about a quarter of all women who give birth use drugs, 46 such as cocaine. About half of the newborn babies who test positive for drugs are removed from their mothers and placed in foster care. Drucker illustrated this practice in a case of a poor Puerto-Rican woman, whose baby was taken away from her after birth. She had a complication of pregnancy known as placenta praevia and the baby died shortly after birth. Annas asked: Does it make any sense to decree that the pregnant woman must, in effect, live for her foetus? That she commits a crime if she does not eat only healthy foods; smokes cigarettes or drinks alcohol; takes drugs (legal or illegal); has intercourse with her husband? Favouring the foetus radically devalues the pregnant woman, and treats 158 Coercive medicine her like an inert incubator, or as a culture medium for the foetus. Women have always been unequal citizens, at least in medical eyes, but this has been obscured by the rhetoric of equality. Women have been barred from employment that was con- sidered harmful to a foetus, even if they were not pregnant. In 1978, American Cyanamid banned all women of childbear- ing age (defined as 16 to 50) from their plant in West Virginia, unless they could prove that they had been sterilised. Free sterilisation was offered and five women accepted it rather 48 than being dismissed. A Nevada woman who drank some beer the day 49 before she went into labour lost custody of her child. The New England Journal of Medicine reported 21 such cases in women who were, as a rule, single, poor, and coloured; Acceptance of forced caesarean sections, hospital deten- tions, and intra-uterine transfusions may trigger demands for court-ordered pre-natal screening, foetal surgery, and restrictions on the diet, work, athletic activity and sexual 50 activity of pregnant women. The woman did not consent, so she was brought to court, where her doctor claimed that there was a 99 per cent probability that the child would die and a 50 per cent probability that the mother would die, if a caesarian section was not performed. She won an appeal to the Georgia Supreme Court and, shortly after- wards, delivered a healthy baby without surgical inter- 52 vention. While some women may be forced to keep their pregnancy against their will others may be prevented from becoming pregnant. It usually takes some 15-20 years before American fashions in public health are adopted in Britain. Yet a High Court in London, in October 1992, ordered an emergency caesarean section on a 30-year-old woman, who refused the operation on religious grounds. In 1992, in Erlangen, Germany, an 18-year-old woman was killed in a car accident and since she was carrying a four-month-old 160 Coercive medicine foetus it was decided to keep the brain-dead woman on a life-support machine until the baby could be delivered. Police powers may even extend to forcing women to undergo a gynaecological examination if there is a suspicion that they have had an illegal abortion abroad. According to a study carried out in 1991 by the Max Planck Institute for Foreign and International Law in Freiburg, there were about ten such cases a year, especially in women returning to Ger- 58 many from the Netherlands. As early as 1963, Erwin Goffman noted that: Only one completely unblushing male in America is a young, married, white, urban, northern, heterosexual Protestant father of college education, fully employed, of good complexion, weight and height and a recent record 60 of sports. Medical screening of healthy humans is the latest addition to collecting information on private citizens. It is the apparent benevolence of the purposes of health screening - to prevent disease and to prolong life - which makes it particularly dangerous, as its more sinister aspects go unnoticed. Epidemiologists, physicians, and other policy makers often treat an estimate of the likelihood of something happening 62 to an individual as an important fact about him. This new statistical or actuarial concept of risk only became part of health promotion rhetoric in the 1970s. This develop- 162 Coercive medicine ment is in line with the neopuritanical tendency towards nor- malisation. Yet, clearly, it is not homosexuality which causes the disease, and even if all homosexuals were exterminated, it would not eradicate the disease. In general, the study of risk factors and their detection in individuals does not bring us nearer to an understanding of causal mechanisms. More often than not, risk factors obscure rather than illuminate the path towards a proper understand- ing of cause. Hagen Kuhn pointed out that prevention based on risk-factor epidemiology is governed by the kind of logic by which room temperature may be lowered by placing the 65 room thermometer into a bucket of ice. The information which accrues from risk-factor screening is hardly ever of any benefit to the person screened, but is of advantage to screeners. In communist countries, regular health checks were often made compulsory, and this is now spreading to Western democracies. Mis- use of screening at the workplace and by insurance companies is discussed below. Allegrante and Sloan provided a psychological explanation for modern victim blaming: We tend to perceive the world as a just place in which people get what they deserve and deserve what they get. This applies not only to those people who are the benefici- aries of positive events, but also to those who are vic- timized by misfortune. Refusal to treat stigmatised persons, however, is now widely supported by the medical profession. In the Erewhonian world illnesses were considered at the same time criminal and immoral.