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Information simply stored in databases or posted on the internet discount benicar 20 mg on-line, even if publicly 199 accessible discount benicar 10 mg on line, may not be searchable or useable to patent examiners buy 10mg benicar. Increasingly, many academic institutions are functioning as for-profit research centers. In addition, net royalty income paid to the University from licensing to pharmaceutical firms is shared, with one-half paid to a Trust Fund for the benefit of the country of origin of the genetic material. Confidentiality, or non-disclosure, agreements keep transferred information private. They may prevent collaborators from sharing knowledge publicly or with other parties. Trade secret protection only applies to information for which reasonable steps have been taken to protect against disclosure. They define the rights and responsibility of both parties with respect to the materials. The distribution of financial benefits may be governed by national laws, and may, for example, require payments for benefit-sharing to go to a community trust fund or government agency rather than to specific individuals. The agreement stipulated that joint patent applications would be made for any collaborative innovations, and that future royalty payments from any licensing agreements would be jointly negotiated. The University of Zimbabwe did not inform the national government or the traditional healers of its agreement 202 with the University of Lausanne. The University of Lausanne then entered into a licensing agreement with Phytera, an American pharmaceutical company, to market diterpenes. The University of Lausanne also decided the percentage of royalty payments it would contribute to the National Herbarium and the Botanical Garden of Zimbabwe and to the Department of 204 Pharmacy at the University of Zimbabwe. In 2003, the University of Lausanne agreed to renegotiate the controversial agreement. Phytera later discontinued its research on diterpenes after negative results emerged from clinical trials. As indicated in The World Intellectual Property Organization Traditional Knowledge 206 Documentation Toolkit (Nov. By far the most important phase of the documentation process occurs prior to documentation. This may be anything from a whole medical system, such as that practiced by traditional healers in Africa and South America, to an individual herb or natural product. This should include individuals traditionally entitled to possess or use the knowledge. This may also include persons who have non- traditionally acquired the knowledge, community members with a specific interest in the knowledge, the entire community or even other communities. On the other hand, if knowledge is restricted to an individual or a particular group within a community, the rights to that knowledge may rest with those persons rather than the entire community. Some countries, 207 such as Brazil, have laws that determine who must be included in documentation efforts. Eduardo Vlez, Brazil s Practical Experience with Access and Benefit-sharing and the Protection of Traditional Knowledge, June 2010 at 1 2. The agreement established the prior informed consent of the Krah people from an organization, Vyty-Cati, which represented the three Krah villages involved in the research. Later attempts to negotiate a new access agreeement failed, and pharmaceutical laboratories stated they were unwilling to finance the project due to concerns that new accusations of 211 bio-piracy might be raised. If documentation is expected to result in financial benefits, how will money be distributed or shared? If possible, major decisions should be by consensus, but different stakeholders may have different goals for documentation (or even oppose documentation). Carlini, Plants with Possible Psychoactive Effects Used by the Krah Indians, Brazil, 28 Rev Bras. Knowledge not already in written form should not be written down until a complete documentation strategy is in place. Depending on the knowledge in question, documentation can be costly and time-consuming. For example, traditional healers may need to be involved in documenting oral traditions or persons with language skills may be necessary to translate written texts. If documentation in electronic registries is desired, this requires computer equipment and technical expertise. For example, anthropologists from developed country universities may have valuable expertise in documenting traditional practices, but there may be concerns about transmitting knowledge outside of the community. The details of any proposed collaboration should be clearly agreed upon prior to the initiation of any substantive discussion, and should be governed by written contract rather than relying on informal agreements. However, just because information is publicly available does not mean it should not be documented. Because it is hard to know in advance what knowledge will prove useful in the future, it may be advisable to document as comprehensively as possible. A documentation plan should be created to detail exactly how data will be acquired and a timeline. If a product is being described, documentation should include all known names, variations, and both traditional and modern uses. If a process is being described, documentation should detail every step in the process, including all of the required materials and any information necessary to allow someone else to recreate the process. Documentation should also contain the name, location and contact information of stakeholders claiming ownership. Data is also significantly more accessible to researchers and patent examiners if provided in an electronic, searchable database. Finally, while full stakeholder involvement should be obtained as early as possible, it should be obtained no later than the beginning of the documentation. Written evidence of prior informed consent to documentation and future uses of traditional knowledge should be obtained. Once the documentation phase is ready to begin, the first step should be to comprehensively gather all existing sources of documentation. Based on existing documentation, stakeholders should evaluate where gaps in knowledge exist. For example, in addition to its modern role in treating peptic ulcer disease, the Chinese herbal formula Yi Wei Tang treats 43 217 yin deficiency from a traditional perspective. Terminology of this nature is useful to include in documentation, however it may not be easily comprehensible to outside parties. This includes efforts by the Indian government to document yoga practices in video. If external collaborators are involved in documentation efforts, these relationships should be carefully managed and the confidentiality of documentation maintained. A clear understanding of how documentation will be used should be in place prior to initiating documentation. It is reported that about 4,000 221 applications a year are submitted in this field domestically.
Every rea- sonable efort has been made to trace copy- right holders and to obtain their permission for the use of copyright material discount benicar 20mg on line. Should you believe that any content in this report does infringe any rights you may possess buy discount benicar 10 mg on line, please contact us at [email protected] cheap benicar 40mg visa. Disclaimer As a multi-stakeholder and collaborative pro- ject, the fndings, interpretations and conclu- sions expressed herein may not necessarily refect the views of all members of the stake- holder groups or the organisations they repre- sent. The report is intended to be for informa- tion purposes only and is not intended as pro- motional material in any respect. The mate- rial is not intended as an ofer or solicitation for the purchase or sale of any fnancial instrument. The report is not intended to provide account- ing, legal or tax advice or investment recommen- dations. Whilst based on information believed to be reliable, no guarantee can be given that it is accurate or complete. The information herein has been obtained from sources which we believe to be reliable, but we do not guaran- tee its accuracy or completeness. Both computer and ebook reader need to be protected from the elements unless they are ruggedized. Hesperian Foundation 2010 $17 for hard copy, pdf free (see below) The Hesperian site has ordering information for the hardcopy and all of the other hardcopy books. Although slanted to the third world and the tropics, it contains the essential basics of all aspects of medicine. Handbook of Medicine in Developing Countries 3 Edition In my opinion, this book competes well for the you must have this one award.. I have rated it (slightly) lower simply because it is more expensive and you can t readily get it as a pdf. Many medical missionaries swear by this book while they are attempting to practice medicine in a developing country often with adverse conditions and inadequate supplies. This third edition of Handbook of Medicine in Developing Countries covers more diseases, has the latest treatment recommendations, includes 16 pages of color pictures of common dermatological diseases, and is easier to use than ever. If you are planning to go on a mission trip, but have never worked overseas, this book is absolutely essential. Browse through it before you travel to prepare yourself for many of the common diseases and problems you will see. This book is highly recommended by my brother, who has been a ship s officer for over 30 years and an All-Seas, All Vessels rated Master for 20. It covers the management of most common problems in an excellent format, designed for ships isolated at sea. This book attempts to describe in nontechnical language, the diseases and medical emergencies most commonly encountered while at sea and the "first aid" and "follow-up" care required until the patient can be evaluated and treated by a physician. It offers alternatives to conventional procedures for management of a given problem that can be used under less than optimal circumstances. Clearly the military has many other resources available for the practitioner of austere medicine. Particularly good for care under fire is the Combat Casualty Care Course and the 91W course. This includes medical care while trekking in third world countries, deep-water ocean sailing, isolated tramping and trekking, and following a large natural disaster or other catastrophe. It s good, relatively complete, and used by many a medical student as a learning manual. An anatomy atlas such as Grays or Grants are also excellent references for any would-be austere surgeons. Of course you could also download the free Android, Win, or iPhone apps available from medscape or Epocrates. A good nursing or paramedic drug reference will also give you a significant reference to drugs, effects, and dosages. Remember that the United States name may not be recognized in other countries eg lidocaine, lignocaine. Amazon $25 (1993) Vital for basic emergency surgical procedures and a stepping stone into more advanced stuff. Check with Amazon or Powell s The Disaster Medicine Textbooks Ciottone, Gregory R. The Borden Institute I haven t read this one completely yet, but the Borden Institute produces a whole lot of good works. Thomas, Hunter s Tropical Medicine & Emerging Infectious Diseases 8th Edition, 2000 W. This sailing classic covers emergency medical care at sea, examining common accidents and ailments which can occur when medical care is unavailable and not likely to be immediate in forthcoming. Diagrams and photos accompany step by step treatment options, while the revised edition includes drugs, dosages, and the latest methods. Not particularly oriented towards austere medical care, but certainly has some aspects. Given its price, I would suggest only those who already have a good basic knowledge of wilderness medicine or need for outdoor medicine consider buying it. Although some of the treatment mentioned in this book are dated, it is still quite in line with appropriate practice. Mayeaux (Author) $120 from Amazon Featuring over 1,300 full-color illustrations, this atlas is a comprehensive, hands-on guide to more than 100 medical procedures most commonly performed in an office setting. The book presents step-by-step instructions and illustrations for each procedure and discusses strategies for avoiding common pitfalls. It does not cover dislocations and some emergency procedures such as tube thoracostomy very well. It is a historical text for the Austere Medical practitioner that deserves to be mentioned in any list of books on the subject. If going to Haiti know the signs, symptoms, treatment, and prophylaxis for Malaria and Cholera. Ethylmercury was more renotoxic than methylmercury tubular dilation was frequently present in kidneys both damage and mercury deposits 24 were more widely spread in ethylmercury-treated rats. David Baskin during the Committee s December 10, 2002 hearing sheds a great deal of light onto the true nature of ethyl versus methylmercury. I have had some people say that data on methylmercury is fairly good, but we don t have good data on ethylmercury. I take it from your testimony there is actually quite a bit of data on ethylmercury and it s as toxic as methylmercury. But from a chemical point of view, most chemical compounds that are ethyl penetrate into cells better than methyl. And ethyl as a chemical compound pierces fat and penetrates fat much better than methyl.
Desquamation of bronchial epithelium can be identified on histologic examination ( 109) or when a patient coughs up clumps of desquamated epithelial cells (creola bodies) order 10mg benicar. Bronchial mucus contains eosinophils order benicar cheap online, which may be observed in expectorated sputum benicar 40mg with amex. Charcot-Leyden crystals (lysophospholipase) are derived from eosinophils and appear as dipyramidal hexagons or needles in sputum. Viscid mucus plugs, when expectorated, can form a cast of the bronchi and are called Curschmann spirals. Clinically, mucus hypersecretion is reduced or eliminated after treatment of acute asthma or inadequately controlled chronic asthma with systemic and then inhaled corticosteroids. Mucus from patients with asthma has tightly bound glycoprotein and lipid, compared with mucus from patients with chronic bronchitis ( 110). Macrophages have been shown to produce a mucus secretagogue as well as generate mediators and cytokines ( 98,111). Because plasma cell staining for IgE was not increased in number, it has been thought that IgE is not produced locally. However, because the lung is recognized as an immunologic organ, further work may that show IgE is produced in the lung. The mechanism of bronchial hyperresponsiveness in asthma is unknown but is perhaps the central abnormality physiologically. However, bronchial hyperresponsiveness is not specific for asthma because it occurs in other patients without asthma ( Table 22. Nevertheless, hyperresponsiveness consists of bronchoconstriction, hypersecretion, and hyperemia (mucosa edema). The bronchial responsiveness detected after challenge with histamine or methacholine measures bronchial sensitivity or ease of bronchoconstriction ( 106). As stated, an additional finding in some patients with asthma is excessive bronchoconstriction, which can be attributable to associated increases in residual volume and possibly more rapid clinical deterioration ( 106). Often, on opening the thorax of a patient who has died from status asthmaticus, the lungs are hyperinflated and do not collapse ( Fig. In some cases, complicating factors, such as atelectasis or acute pneumonia, are identified. Upon histologic examination, there is a patchy loss of bronchial epithelium with desquamation and denudation of mucosal epithelium. Other histologic findings include hyperplasia of bronchial mucus glands, bronchial mucosal edema, smooth muscle hypertrophy, and basement membrane thickening (Fig. Occasionally, bronchial epithelium is denuded, but histologic studies do not identify eosinophils. Similarly, although many autopsy examinations reveal the classic pattern of mucus plugging ( Fig. Eosinophils have been identified in such cases in airways or in basement membranes, but a gross mechanical explanation, analogous to mucus suffocation, is not present. A third morphologic pattern of patients dying from asthma is that of mild to moderate mucus plugging (107). Some patients dying from asthma have evidence of myocardial contraction band necrosis, which is different from myocardial necrosis associated with infarction. Contraction bands are present in necrotic myocardial smooth muscle cell bands in asthma and curiously the cells are thought to die in tetanic contraction whereas in cases of fatal myocardial infarction, cells die in relaxation. Pleural pressure becomes more negative, so that as inspiration occurs, the patient is able to apply sufficient radial traction on the airways to maintain their potency. Air can get in more easily than it can be expired, which results in progressively breathing at higher and higher lung volumes. The residual volume increases several-fold, and functional residual capacity expands as well. The lung hyperinflation is not distributed evenly, and some areas of the lung have a high or low ventilation-perfusion ratio ( / ). Overall, the hypoxemia that results from status asthmatics occurs from reduced /, not from shunting of blood. The lung hyperinflation also results in dynamic autopeep as the patient attempts to maintain airway caliber by applying some endogenous positive airway pressure. There is no evidence of chest wall (inspiratory muscle) weakness in patients with asthma. Nevertheless, some patients who have received prolonged courses of daily or twice-daily prednisone or who have been mechanically ventilated with muscle relaxants and corticosteroids can be those who have respiratory muscle fatigue. After successful treatment of an attack of status asthmaticus, the increases in lung volume may remain present for 6 weeks. Small airways may remain obstructed for weeks or months; in some patients, they do not become normal again. At the same time, it can be expected that the patient has no sensation of dyspnea within 1 week of treatment of status asthmaticus despite increases in residual volume and reduced small airways caliber. This divergence between symptom recognition in asthma and physiologic measurements has been demonstrated in ambulatory patients who did not have status asthmaticus (114). The reduction in trapped gas in the lung can result in symptom reduction even without improvement in expiratory flow rates. In summary, asthma pathophysiology includes poor or impaired symptom perception in some patients. There may be poor sensitivity or discrimination (recognizing improvement or worsening status) (115). Even this list is oversimplified because asthma must be considered a very complex condition in terms of airway caliber and tone. Selected neuropeptides and their proposed actions in asthma Mediator release caused by mast cell activation results in acute and late bronchial smooth muscle contraction, cellular infiltration, and mucus production. The neurotransmitter for postganglionic parasympathetic nerves is acetylcholine, which causes smooth muscle contraction. However, there appears to be little if any significant smooth muscle relaxation through stimulation of postganglionic sympathetic nerves. Circulating endogenous epinephrine apparently does not serve to produce relaxation of smooth muscles. Sensory nerves in the respiratory epithelium are stimulated and lead to release of a host of neuropeptides that may be potent bronchoconstrictors or bronchodilators. Respiratory epithelium itself may contain bronchi-relaxing factors that may become unavailable when epithelium is denuded. Although much attention has been directed at understanding the contribution of IgE and mast cell activation in asthma, triggering or actual regulation of some of the inflammation of asthma may occur because of other cells in lungs of patients. These cells, as well as mast cells in the bronchial mucosa or lumen, can be activated in the absence of classic IgE-mediated asthma. Bronchial biopsy specimens from patients with asthma demonstrate mucosal mast cells in various stages of activation in patients with and without symptoms (117,118). Mast cell hyperreleasibility may occur in asthma, in that bronchoalveolar mast cells recovered during lavage contain and release greater quantities of histamine when stimulated by allergen or anti-IgE in vitro (119,120).
This can cause difculty with swal- r Plasmapheresis and intravenous immunoglobulin are lowing and eating the chin may need support whilst usually reserved for severe acute exacerbations 40 mg benicar overnight delivery. The respiratory muscles may be affected in Severity uctuates but most have a protracted course generic benicar 10 mg otc, amyasthenic crisis requiring ventilatory support purchase benicar cheap online. Ini- exacerbations are unpredictable but may be brought on tially the reexes are preserved but may be fatiguable, by infections or drugs. Aetiology/pathophysiology Investigations Antibodies directed against the presynaptic voltage- r Edrophonium (anticholinesterase) Tensilon test gated calcium channels have been detected. The ocular and smell) although this may be found in elderly patients bulbar muscles are typically spared. Test ability of each nos- gravis, weakness tends to be worst in the morning and tril to detect several common smells. The optic nerve Investigations Anatomy r Nerveconduction studies show an incremental re- The optic nerve carries information from the retina via sponse when a motor nerve is repetitively stimulated, the optic chiasm, the lateral geniculate bodies and optic in direct contrast to the ndings in myasthenia gravis radiation to the occipital lobe where the visual cortex is (where there is a decremental response). Vision Management Clinical features Treatment of the underlying tumour can lead to These depend on the location of the lesion (see Fig. Plasmapheresis and intravenous im- Field loss: munoglobulin may be used, and drugs which increase r Eye lesions include diabetic retinal vascular disease, acetylcholine release from presynaptic terminals appear glaucoma, retinitis pigmentosa. The olfactory receptors lie in the olfactory epithelium r Tunnel vision occurs in other conditions, e. The axons form bundles which pass through the Diseasesaffectingtheopticnerveandtherestoftheoptic cribiform plate (ethmoid bone) to the olfactory bulb. The olfactory bulb neurones project through the olfactory tract to the Abnormalities of the optic disc frontal cerebral hemispheres, the medial temporal lobe and the basal ganglia. Denition The optic disc is where the retinal bres meet to form Function the optic nerve. Diseases affecting the optic nerve may Smell cause the disc to look abnormal: 1 Swollen, i. Papilloedema Management This term should be reserved to describe swelling of the Directed at the underlying cause. The increased pressure causes axonal transport to become abnormal, causing swelling of the Horner s syndrome nerves. The term is often used to cover all causes of a swollen disc, but this is the differential diagnosis of papilloedema (see Table 7. Optic atrophy Optic atrophy may follow any damage to the optic nerve, Clinical features particularly after ischaemia, optic neuritis and optic The condition presents with unilateral pupillary con- nerve compression. Associated features Clinical features may include a hoarse voice (due to either recurrent la- The degree of visual loss depends on the underlying ryngeal nerve palsy or lower cranial nerve involvement), cause. Optic neuritis and ischaemic neuropathy typically or signs in the neck, chest or hands pointing to the level cause early visual loss. Location of lesion Examples r Inferior ramus travels with superior ramus, but gives Sympathetic chain Carotid artery aneurysm or branches to inferior rectus and medial rectus muscles. It exits pos- wall of the cavernous sinus, then divides into: teriorly from the brainstem and winds around to the r Superior ramuswhich enters orbit via the lower part front, then passes in the lateral wall of the cavernous of superior orbital ssure within a tendinous ring. It exits from the brainstem and 1 V supplies the forehead, the upper eyelid and eyeball. Pain and temperature bres are also carried on the three divisions back to the trigeminal ganglion, but then dive Specic causes down into the medulla to the spinal nucleus of V which Particularly at risk from raised intracranial pressure or extends as far as the upper cervical cord. If touch is lost, but pain and temperature intact, Emerges as two roots (large sensory and small motor the lesion has to be in the pons or medulla. The Function motor nerve cell bodies are in the facial nerve nucleus in The motor components supply the muscles of mastica- the pons. Here the sensory nerve Management cellbodies cause a swelling called the geniculate ganglion If the patient is unable to close their eye completely, ar- and give off the nerve to stapedius and chorda tympani ticial tears should be used and the eye taped shut at (taste and lacrimation) before exiting the skull through night to prevent corneal ulceration. In cases that do not resolve tars- (frontalis) receives some innervation from each hemi- orrhaphy (suturing of upper to lower lid, laterally) may sphere, so that unilateral upper motor neurone lesions be necessary. Cosmetic surgery and/or reinnervation us- cause sparing of the forehead, whereas unilateral lower ing a lingual nerve transfer for example, can be used for motor neurone lesions cause forehead involvement. Function Prognosis Muscles of facial expression and taste of the anterior two A signicant proportion do not completely resolve and third of the tongue. The auditory bres arise from the cochlea and pass to the pontine auditory nucleus. The Clinical features vestibular nerves arise from the semicircular canals and The features of facial nerve palsy depend on the level pass to the vestibular nuclei in the pons, and the cerebel- of the lesion. Hyperacusis (hearing sounds louder than normal) sug- gests a lesion proximal to the stapedial branch. Function Hearing (cochlear nerve) and movement/position of head in space, for balance and head eye coordination Bell s palsy (vestibular nerve). As it is a lower motor neurone decit, the forehead is affected and the eye may not be able to close Clinical features completely. It usually begins to improve spontaneously Sensorineural deafness, tinnitus, vertigo, nystagmus. Anatomy Glossopharyngeal receives taste and common sensation This arises from the hypoglossal nucleus in the medulla, from the posterior third of the tongue, the oropharynx and is a motor nerve supplying the muscles of tongue viathe pharyngeal plexus, and the tonsillar fossa and soft except palatoglossus. It also carries autonomic innerva- Function tion to the heart, respiratory tract and gut. Specic causes Specic causes Stroke, bulbar palsy, polio, trauma and tuberculosis. Central causes include vascular lesions of the medulla, tumours, syringobulbia and motor neurone disease. Aneurysms and tumours in the posterior fossa and Clinical features meningitis may affect the nerves. The left recurrent la- Tongue deviates to side of lesion when patient is asked ryngeal nerve (a branch of the vagus) may be damaged to stick tongue out. In some cases there is a pure motor or pure sensory decit, but in most there is a combination of both. Damage to the peripheral nerves are Anatomy caused by a number of mechanisms, principally Spinal accessory branch arises from upper cervical cord r demyelination, segments and passes through the foramen magnum to r axonal loss, join the cranial accessory branch. They leave the skull r compression or traumatic sectioning of a nerve, separately through the jugular foramen. Function Cranial nerves join the pharyngeal plexus and supply the Mononeuropathies: Involvement of a single nerve. The spinal Traumatic peripheral nerve injuries may result from part supplies trapezius and sternocleidomastoid. Traumatic nerve damage may result in: r Neuropraxia, a transient loss of physiological function Specic causes with no loss in continuity and no degeneration. Clinical features r Axonotmesis, which follows more severe compression Weakness of lifting ipsilateral shoulder and turning head or traction damage, with Wallerian degeneration of against resistance towards the contralateral side. The nerve bun- dleisinterrupted, in-growth of brous tissue pre- vents re-innervation, so that surgical repair is needed Incidence if function is to be restored.
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